H.Lundbeck A/S: Experts Call for Urgent Action to Better Diagnose Severe Form of Bipolar I Disorder, Which is Costing Healthcare Economies Billions1,2

LONDON

A new report launched today, ‘Paying the ultimate price’, highlights the urgent need for accurate diagnosis and management of bipolar I disorder in order to address a significant burden on society, patients and carers.^1,2,3,4 Due to lack of understanding of a severe form of bipolar I disorder (mania with depressive symptoms), millions of people worldwide are not receiving timely and accurate diagnosis leaving them at a heightened risk of suicide, according to world-leading experts.⁵

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In recent years, bipolar I disorder has been re-defined through recognition that manic and depressive symptoms can occur concurrently; these feelings of depression during mania occur in over two thirds of patients and represents a severe form of bipolar I disorder.⁶ Patients are at their most vulnerable at this time, with up to one out of two sufferers attempting suicide during these episodes.³ They are also approximately three times more likely to be hospitalised than bipolar patients without mixed symptoms,⁷ and the duration of these hospital stays are on average 40 per cent longer.⁸ Aside from the impact this has on friends, family and society, the financial burden of suicide attempts and hospitilisations are also significant.^9,10

Professor Michael Berk, Professor of Psychiatry, School of Medicine, Deakin University, Australia, comments: “Typically we see greater morbidity, younger age of onset, more episodes and shorter intervals between episodes amongst bipolar I disorder patients experiencing mania with depressive symptoms. These patients are more likely to attempt suicide than during a purely manic episode and have a higher number and longer duration of hospitalisations.”

Professor Eduard Vieta, Director of the Bipolar Disorders Program of the Hospital Clinic at the University of Barcelona, Spain, comments: “It is important to ensure that patients experiencing mania with depressive symptoms are diagnosed quickly and accurately. We now understand that almost three quarters (72%) of patients experiencing mania with depressive symptoms report symptoms of anxiety, irritability or agitation. Simple recognition of these hallmarks can enable healthcare professionals to intervene and treat patients, reducing hospitalisations often costing healthcare economies billions of euros and potentially saving thousands of lives worldwide.”

The direct costs, such as caring for patients who have attempted suicide, are estimated at €6.45 billion a year in the US alone.¹¹ Evidence reveals that 45 per cent of direct costs associated with suicide are attributable to hospitalisation,¹² costing approximately €23,000 within the first year after a suicide attempt in the US.³ The indirect costs associated with bipolar I disorder also have a huge impact on society, patients and carers. Evidence has shown that over one sixth (16.5%) of indirect costs are incurred by lost productivity of family members and caregivers in the US;¹³ and it is estimated that the indirect costs are 4 times higher than the direct costs.¹⁴

Mr Paul Arteel, Executive Director of Global Alliance of Mental Illness Advocacy Networks (GAMIAN) Europe comments: “Bipolar I disorder, in particular mania with depressive symptoms, has a severe effect on those living with the condition. It not only has a significant impact on the patient’s life, but has a drastic effect on their family and friends – who are often also their ‘carers’. We find that family and friends close to bipolar I disorder patients can live in constant fear that suicide could take the lives of their loved ones.”

Despite the significant financial burden and increased risk of suicide among this patient community, 72 per cent of psychiatrists are unaware that up to 64 per cent of people diagnosed with bipolar I disorder experience at least one depressive symptom during an episode of mania.¹⁵ This lack of recognition could lead to the misdiagnosis of vulnerable people with bipolar I disorder, putting them at greater risk of suicidality and placing a devastating burden on families and carers.

Professor Maurizio Pompili, Professor of Suicidology, Faculty of Medicine and Psychology of Sapienza University, Italy, who contributed to the report, said: “Suicide prevention among bipolar I patients could be improved through greater education and understanding of depressive symptoms during mania. Psychiatrists are too often afraid to broach the topic of suicidality with their patients, as they are fearful they may seed such an idea. This is sadly the opposite of what patients need; a combination of intervention and human support is vital. It is important that psychiatrists ask and understand why patients either want to attempt suicide or have attempted suicide; how can patients move forward when they haven’t understood why it happened in the first place?”

The ‘Paying the ultimate price’ report has been developed by a global faculty of expert psychiatrists, a suicidologist, patient group representatives and carers affected by bipolar I disorder in collaboration with H. Lundbeck A/S. It calls for an improvement in diagnosis and management of mania with depressive symptoms, as well as greater support around the associated risk of suicide. The full report can be dowloaded here.

*In the first year following a suicide attempt in the US

—Ends—

For more information please visit www.bipolarmania.net and connect with us on twitter @Spotlight_BP and on Instagram @SPOTLIGHTBIPOLAR.

Notes to editors

About the ‘Paying the ultimate price’ report

H. Lundbeck A/S, in collaboration with the global MANIA⁶⁴ faculty, a suicidologist and patient advocacy groups developed the report to highlight the huge burden on society associated with bipolar I disorder and mania with depressive symptoms, and call for heightened awareness and education around this debilitating disorder. It highlights the very high monetary cost of caring for people with bipolar disorder; in Europe this can exceed €21.5 billion,² whilst in the US figures are approximately €139 billion per annum.¹

A meeting was hosted by H. Lundbeck A/S in March 2015 with the MANIA⁶⁴ faculty, to gain their advice and insights regarding the content of the report. In addition, H. Lundbeck A/S conducted a literature review to investigate the costs and the impact of suicidality associated with bipolar I disorder and mania with depressive symptoms.

Evidence has also shown that the indirect costs of bipolar disorders are known to be four times greater than direct costs, placing a significant burden on healthcare systems and society.^14,16,17 This report calls for an improvement in diagnosis and management of mania with depressive symptoms as well as greater support around the associated risk of suicide.

A group of global psychiatrist experts, known as the MANIA⁶⁴ faculty, developed the report:

• Lead author: Professor Eduard Vieta – Spain
• Professor Allan Young – UK
• Professor Roger McIntyre – Canada
• Professor Andrea Fagiolini – Italy
• Professor Olavo Pinto – Brazil
• Professor Michael Berk – Australia
• Doctor Umberto Albert – Italy
• Doctor Jose M Goikolea – Spain

The report was also developed with the support of:

• Professor Maurizio Pompili, Italy
• Global Alliance of Mental Illness Advocacy Networks Europe: patient advocacy group
• A number of carers affected by bipolar I disorder

The campaign is supported by H. Lundbeck A/S.

About Bipolar I disorder and mania with depressive symptoms

Bipolar I disorder is one of the most common and debilitating psychiatric disorders and is associated with an increased risk of suicide.¹⁸ It is a chronic illness characterised by episodes of mania and depression.¹⁹

People diagnosed with bipolar I disorder display some or all of manic and depressive symptoms, such as: feeling high or overly happy, extreme irritability and agitation, adopting high-risk behaviours, overly long periods of feeling sad or hopeless, problems concentrating, experiencing anxiety, thinking of death or suicide, or attempting suicide.¹⁹

During episodes of mania, depressive symptoms often occur concurrently, with intervening periods of ‘remission’, which are relatively (but not fully) symptom-free.⁵ Mania with depressive symptoms represents a severe form of bipolar I disorder.⁶ According to the DSM-5 criteria, a person experiencing three or more depressive symptoms during an episode of mania is suffering from mania with depressive symptoms; this is reported in 39 per cent of patients.⁶

Most people (64 per cent) diagnosed with bipolar I disorder will suffer from at least one concurrent depressive symptom during an episode of mania.⁶

Bipolar disorder is thought to affect up to 2 per cent of Europeans at some point in their life, of which approximately half will develop bipolar I disorder.^20,21 The lifetime risk of suicidal behaviours amongst bipolar patients is estimated to be up to 54 per cent.⁹

About MANIA⁶⁴

MANIA⁶⁴ is a disease awareness campaign that aims to raise awareness of mania with depressive symptoms in people diagnosed with bipolar I disorder and prompt timely diagnosis and greater recognition of diagnostic indicators, anxiety and irritability and agitation.

About H. Lundbeck A/S

H.Lundbeck A/S (LUN.CO, LUN DC, HLUYY) is a global pharmaceutical company specialized in brain diseases. For more than 70 years, we have been at the forefront of research within neuroscience.

Our key areas of focus are alcoholic dependence, Alzheimer’s disease, bipolar disorder, depression, anxiety, epilepsy, Huntington’s disease, Parkinson’s disease, schizophrenia and symptomatic neurogenic orthostatic hypotension (NOH).

An estimated 700 million people worldwide are living with brain disease and far too many suffer due to inadequate treatment, discrimination, a reduced number of working days, early retirement and other unnecessary consequences. Every day, we strive for improved treatment and a better life for people living with brain disease – we call this Progress in Mind.

For additional information, we encourage you to visit our corporate site www.lundbeck.com and connect with us on Twitter at @Lundbeck.

References

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² Olesen J, et al. Eur J Neurol. 2012;19:155–162.

³ Bonnin CM, et al. J Affect Disord. 2012;136(3):650-9.

⁴ National Depressive and Manic-Depressive Association. Living with Bipolar Disorder: How Far Have We Really Come? Constituency Survey. Available at: http://tinyurl.com/q3jy76w. Last accessed May 2015.

⁵ Jann MW. Am Health Drug Benefits. 2014;7(9):489-499.

⁶ Vieta E, et al. J Affect Disord. 2014;156:206–213.

⁷ Ostergaard SD, Bertelsen A, Nielsen J, Mors O, Petrides G. The association between psychotic mania, psychotic depression and mixed affective episodes among 14,529 patients with bipolar disorder. J Affect Disord 2013; 147: 44–50.

⁸ Ösby U et al. J Affect Disord. 2009;115:315-322

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¹² Mapelli, V, et al. PharmacoEconomics Italian Research Articles. 2005;7(2):101-118.

¹³ Wyatt RJ, Henter I. Soc Psychiatry Psychiatr Epidemiol. 1995;30:213–219.

¹⁴ Valenti, et al. Bipolar Disord. 2011;13:145–154.

¹⁵ H. Lundbeck A/S, survey of psychiatrists, April 2015

¹⁶ Miller S, et al. J Affect Disord. 2014; 169 (Suppl 1): S3–S11.

¹⁷ Baldessarini RJ, et al. CNS Spectr. 2006;11:465–471.

¹⁸ Gao K et al. Neuropsychiatr Dis Treat. 2013;9:1145-1157

¹⁹ Bipolar Disorder in Adults. NIMH. http://tiny.cc/_NIMH (last accessed 07.05.15)

²⁰ Merikangas KR et al. Arch Gen Psychiatry. 2011;68(3):241-251

²¹ Pini S et al. Eur Neuropsychopharmacol. 2005;15(4):425-434

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