title: Trends in the psychopharmacological treatment of bipolar disorder: a nationwide register-based study.
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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: 1Research Department P,Aarhus University Hospital,Risskov,Denmark.
authors.forename: Louise
authors.identifier: http://orcid.org/0000-0003-0093-2388
authors.initials: L
authors.lastname: Bjørklund
authors.affiliation: 2National Centre for Register-based Research,Aarhus University,Aarhus,Denmark.
authors.forename: Henriette Thisted
authors.initials: HT
authors.lastname: Horsdal
authors.affiliation: 1Research Department P,Aarhus University Hospital,Risskov,Denmark.
authors.forename: Ole
authors.initials: O
authors.lastname: Mors
authors.affiliation: 1Research Department P,Aarhus University Hospital,Risskov,Denmark.
authors.forename: Søren Dinesen
authors.initials: SD
authors.lastname: Østergaard
authors.affiliation: 2National Centre for Register-based Research,Aarhus University,Aarhus,Denmark.
authors.forename: Christiane
authors.initials: C
authors.lastname: Gasse
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000928:Antidepressive Agents / Q000627:therapeutic use*; D001714:Bipolar Disorder / Q000188:drug therapy* / Q000523:psychology*; D002648:Child; D003718:Denmark; D004358:Drug Therapy / Q000639:trends*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012042:Registries; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D000928:Antidepressive Agents
keywords: antidepressants; bipolar disorder; mood stabilisers; psychopharmacology