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Trends in the psychopharmacological treatment of bipolar disorder: a nationwide register-based study

Published online by Cambridge University Press:  11 September 2015

Louise Bjørklund Open the ORCID record for Louise Bjørklund [Opens in a new window] ,
Henriette Thisted Horsdal ,
Ole Mors ,
Søren Dinesen Østergaard  and
Christiane Gasse
Louise Bjørklund*
Affiliation:
Research Department P, Aarhus University Hospital, Risskov, Denmark
Henriette Thisted Horsdal
Affiliation:
National Centre for Register-based Research, Aarhus University, Aarhus, Denmark
Ole Mors
Affiliation:
Research Department P, Aarhus University Hospital, Risskov, Denmark The Initiative for Integrative Psychiatric Research (iPSYCH), Aarhus, Denmark Centre for Integrated Register-Based Research at Aarhus University (CIRRAU), Aarhus, Denmark
Søren Dinesen Østergaard
Affiliation:
Research Department P, Aarhus University Hospital, Risskov, Denmark The Initiative for Integrative Psychiatric Research (iPSYCH), Aarhus, Denmark Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
Christiane Gasse
Affiliation:
National Centre for Register-based Research, Aarhus University, Aarhus, Denmark
*
Louise Bjørklund, Research Department P, Aarhus University Hospital, Risskov, Denmark. Tel: +45 41697948; Fax: +45 78471609; E-mail: louibjoe@rm.dk
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Abstract

Objective

In bipolar disorder, treatment with antidepressants without concomitant use of mood stabilisers (antidepressant monotherapy) is associated with development of mania and rapid cycling and is therefore not recommended. The present study aimed to investigate the psychopharmacological treatment patterns in bipolar disorder over time, with a focus on antidepressant monotherapy.

Methods

Cohort study with annual cross-sectional assessment of the use of psychotropic medications between 1995 and 2012 for all Danish residents aged 10 years or older with a diagnosis of bipolar disorder registered in the Danish Psychiatric Central Research Register. Users of a given psychotropic medication were defined as individuals having filled at least one prescription for that particular medication in the year of interest.

Results

We identified 20 618 individuals with bipolar disorder. The proportion of patients with bipolar disorder using antidepressants, atypical antipsychotics and anticonvulsants increased over the study period, while the proportion of patients using lithium, typical antipsychotics and benzodiazepines/sedatives decreased. The proportion of patients treated with antidepressant monotherapy decreased from 20.5% in 1997 to 12.1% in 2012, and among antidepressant users, the proportion in monotherapy decreased from 47.7% to 23.9%, primarily driven by a decrease in the use of tricyclic antidepressants.

Conclusion

The results show an increase in the proportion of patients with bipolar disorder being treated with antidepressants in the period from 1997 to 2012. However, in accordance with international treatment guidelines, the extent of antidepressant monotherapy decreased during the same period.

Keywords

antidepressantsbipolar disordermood stabiliserspsychopharmacology
Type
Original Articles
Information
Acta Neuropsychiatrica , Volume 28 , Issue 2 , April 2016 , pp. 75 - 84
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Copyright
© Scandinavian College of Neuropsychopharmacology 2015 

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