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Pharmacological treatment and risk of psychiatric hospital admission in bipolar disorder

Published online by Cambridge University Press:  02 January 2018

Erik Joas
Affiliation:
Institute of Neuroscience and Physiology, Department of Psychiatry and Neurochemistry, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
Alina Karanti
Affiliation:
Institute of Neuroscience and Physiology, Department of Psychiatry and Neurochemistry, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
Jie Song
Affiliation:
Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
Guy M. Goodwin
Affiliation:
Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK
Paul Lichtenstein
Affiliation:
Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
Mikael Landén
Affiliation:
Institute of Neuroscience and Physiology, Department of Psychiatry and Neurochemistry, The Sahlgrenska Academy, University of Gothenburg, Gothenburg and Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
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Abstract

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Background

Clinical trials have examined the efficacy of drugs to prevent relapse in patients with bipolar disorder, however, their design often limits generalisation to routine clinical practice.

Aims

To estimate the effectiveness of drugs used for maintenance treatment in bipolar disorder.

Method

We used national registers to identify 35022 individuals diagnosed with bipolar disorder and information on lithium, valproate, carbamazepine, lamotrigine, quetiapine and olanzapine treatment from 2006 to 2009. The main outcome was psychiatric hospital admissions. We used stratified cox regression to compare periods on and off medication within the same individual.

Results

Medication with lithium, valproate, lamotrigine, olanzapine and quetiapine was associated with reduced rates of admission to hospital. Lithium was more effective than quetiapine and olanzapine. The effects of specific drugs depended on the polarity of the mood episode.

Conclusions

Our findings complement results from randomised controlled trails, but suggest that lithium is more effective than both quetiapine and olanzapine in routine clinical practice.

Type
Papers
Copyright
Copyright © Royal College of Psychiatrists, 2017 

Footnotes

Declaration of interest

A.K. declares that, over the past 36 months, she has received lecture honoraria from Eli Lilly Sweden. M.L. declares that, over the past 36 months, he has received lecture honoraria from Biophausia Sweden, Servier Sweden, AstraZeneca. G.M.G. has held grants from Servier, received honoraria for speaking or chairing educational meetings from Abbvie, AZ, GSK, Lilly, Lundbeck, Medscape, Servier, and advised AZ, Cephalon/Teva, Lundbeck, Merck, Otsuka, P1vital, Servier, Sunovion and Takeda, and holds shares in P1vital.

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