A quarter of patients with bipolar disorder are receiving medications that may worsen symptoms, a new study says.
A survey conducted by the University of Glasgow found that many bipolar patients are on a combination of medication that is in disagreement with clinical guidelines.
The study shows a decline in the first treatment recommended for people with mental health condition.
Experts have described the findings as a "concern."
The lithium prescribed on its own is the first recommended treatment for bipolar disorder.
But the study of more than 23,000 patients across Scotland between 2007 and 2016 found that their use is declining, and is now prescribed to only one in 20 people with the disease.
The drug is recommended as a first-line treatment because it has proven efficacy in preventing episodes of depression and mania.
On the other hand, nearly 25% of patients were taking antidepressants as their only drug treatment.
Experts say that this approach may run the risk of antidepressants causing mood worsening and episodes of mania.
This only exacerbates the manic episodes & # 39;
Jamie Stewart is a 37-year Dundee graphic designer. He was diagnosed with bipolar disorder at age 23 and was prescribed antidepressants at various times since then.
Now in a two-course course, including lithium, he says anti-depressants have done nothing to stabilize his mood.
Jamie says, "This only exacerbates the manic episodes. The only way I can describe taking antidepressants is that it kind of cycles my craze – I always ended up where I was.
"I would say, however, that in the days when I was depressed, antidepressants seemed to have a positive effect. I was still depressed, but I grew up a bit.
"But when the craze was there, I just tipped the balance, I really did nothing to balance that." Being a bipolar person, I'm always looking at the middle and not at myself.
"There is a high level with which I am very comfortable, but there is a high point when I feel this is very bad. So you get a mix of mania, where you feel high and low, and it's a really uncomfortable place to be .
"You know you will not be able to relax for a long time and it's just an unpleasant feeling. It's scary when you know the train is not stopping so soon and you'll have to stay at it."
Daniel Smith, a professor of psychiatry at the University of Glasgow, who led the study, said: "These findings are cause for concern.
"They suggest that many people in Scotland with bipolar disorder may not be getting the best drug treatment."
He added, "Specifically, we found that there was a gradual decline in lithium prescription and a consistent pattern of high prescribing antidepressants on their own.
"For many patients, the use of antidepressants in bipolar disorder runs the risk of worsening the course of the disease in the long term rather than improving.
"It is not clear why psychiatrists are prescribing less lithium – it may be because of changes in clinical training or because of effective drug marketing as antipsychotics."
What is bipolar disorder?
- There are different types of bipolar. Those with Type 1 experience periods of high manic and depressive depressions. Those with type 2 experience severe depression and mild manic episodes – known as hypomania – that last for a short period of time. Those with cyclothymia experience fewer severe mood changes, but may last longer.
- During a manic episode, those with bipolar disorder may feel euphoric and have lots of energy, ambitious plans and ideas. But they can become aggressive and experience symptoms of psychosis.
- The exact cause of bipolar disorder is unknown. Some experts believe that it can be developed as a result of severe emotional stress as a child, as well as genetic and chemical factors.
- One in every 100 adults in the UK will be diagnosed with the disease at some point in their life.
Sources: NHS, Royal College of Psychiatrists and Mind
The study looked at patients' hospital records and found that bipolar patients being prescribed were increasing other medications, such as antipsychotics and anticonvulsants.
That, though, the researchers say, none of these are proven to be as effective as lithium in managing the disorder in the long run.
Alison Cairns, executive director of Bipolar Scotland, said, "For some time we have been concerned about the number of people being prescribed antidepressants without a mood stabilizer.
"We urge everyone to have a constructive discussion with their doctor to make sure they are getting the best possible medicine and to know what they are taking. We strongly support physician-patient partnerships."
Prof. Allan Young, president of the British Association of Psychopharmacology, added: "Patients are most often prescribed a treatment (antidepressants), which has little or no evidence of benefit in bipolar disorder and rarely prescribed treatment with more evidence of benefit, lithium.
"Physicians should strive to improve prescription practice and align this with the scientific evidence and treatment guidelines."