Health disparities in the treatment of bipolar disorder

Background: Therapeutic options for bipolar disorder vary based on individual presentation and phase of illness. In addition to well documented disparities in diagnosis, racial and gender differences in treatment complicate efforts to provide effective individualized treatment to patients with bipolar disorder. The present work was undertaken to identify the persistence of racial and gender disparities across diverse community and national populations and to compare treatment disparities in bipolar disorder with those observed for schizophrenia. Methods: Commonly prescribed treatments for bipolar disorder and schizophrenia were quantified using information gathered from the All of Us Research Program and de-identified electronic health records at the University of Mississippi Medical Center. Results: Black patients with bipolar disorder, in comparison to white patients, had significantly less utilization of lithium, lamotrigine, and antidepressants, but greater utilization of haloperidol and other first-generation antipsychotics. Disparities in antipsychotic use were reduced in patients with schizophrenia compared to those with a bipolar diagnosis. Conclusions: The disparities enumerated here have real world clinical implications. Black patients with bipolar disorder have less utilization of lithium, the gold standard mood stabilization treatment. Further community-guided research to better understand the origins of these disparities and clinical trials to evaluate non-antipsychotic mood stabilization treatment for bipolar disorder across populations is warranted.