{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,17]],"date-time":"2026-10-17T01:36:53Z","timestamp":1792201013693,"version":"4.4.0"},"reference-count":28,"publisher":"Georg Thieme Verlag KG","issue":"03","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pharmacopsychiatry"],"published-print":{"date-parts":[[2021,5]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>\nIntroduction The aim of this study was to compare the outcomes of monotherapy in individuals with bipolar disorder who are prescribed lithium, valproate, quetiapine, olanzapine, venlafaxine, or citalopram in private psychiatric practices in Germany.<\/jats:p><jats:p>\nMethods This retrospective study included bipolar disorder patients who had initially started on a monotherapy with lithium, valproate, quetiapine, olanzapine, venlafaxine, or citalopram in 93 private neuropsychiatric practices in Germany between January 2006 and December 2017. Treatment failure was defined as time to discontinuation of medication or addition of another mood stabilizer, antipsychotic, antidepressant, or benzodiazepine.<\/jats:p><jats:p>\nResults A total of 4990 bipolar patients was examined for the period between 2006 and 2019. Initially, monotherapy with lithium (n=1.098), valproate (n=502), quetiapine (n=927), olanzapine (n=927), venlafaxine (n=574), or citalopram (n=962) was prescribed. Within 24 months, treatment failure had occurred in 76.3% (lithium), 85.1% (valproate), 84.6% (quetiapine), 85.2% (venlafaxine), 92.1% (olanzapine), and 86.6% (citalopram) of patients, respectively. The hazard ratio for treatment failure compared to lithium as reference was highest for olanzapine at 1.66 (1.46\u20131.88), followed by citalopram 1.27 (1.15\u20131.39), quetiapine 1.18 (1.07\u20131.29), valproate 1.18 (1.06\u20131.33), and venlafaxine 1.14 (1.02\u20131.27).<\/jats:p><jats:p>\nConclusions Our results underline the importance of lithium in the maintenance treatment of bipolar disorders.<\/jats:p>","DOI":"10.1055\/a-1348-1523","type":"journal-article","created":{"date-parts":[[2021,1,25]],"date-time":"2021-01-25T23:58:31Z","timestamp":1611619111000},"page":"126-130","source":"Crossref","is-referenced-by-count":8,"title":["Bipolar Disorder and Outcomes of Monotherapy with Lithium, Valproate, Quetiapine, Olanzapine, Venlafaxine, and Citalopram"],"prefix":"10.1055","volume":"54","author":[{"given":"Jens","family":"Bohlken","sequence":"additional","affiliation":[{"name":"Institute for Social Medicine, Occupational Medicine, and Public Health (ISAP) of the Medical Faculty, University of Leipzig, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steffi","family":"Riedel-Heller","sequence":"additional","affiliation":[{"name":"Institute for Social Medicine, Occupational Medicine, and Public Health (ISAP) of the Medical Faculty, University of Leipzig, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2666-859X","authenticated-orcid":false,"given":"Michael","family":"Bauer","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Medical Faculty, Technische Universit\u00e4t Dresden, Dresden, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karel","family":"Kostev","sequence":"additional","affiliation":[{"name":"Epidemiology, IQVIA, Frankfurt, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2021,1,25]]},"reference":[{"key":"ref1","doi-asserted-by":"crossref","first-page":"149","DOI":"10.1111\/acps.12133","article-title":"Neuropsychological testing of cognitive impairment in euthymic bipolar disorder: An individual patient data meta-analysis","volume":"128","author":"C Bourne","year":"2013","journal-title":"Acta Psychiatr Scand"},{"key":"ref2","doi-asserted-by":"crossref","first-page":"194","DOI":"10.1111\/bdi.12775","article-title":"Functional outcome assessment in bipolar disorder: A systematic literature review","volume":"21","author":"M Chen","year":"2019","journal-title":"Bipolar Disord"},{"key":"ref3","first-page":"18","article-title":"The prevalence and burden of bipolar disorder: Findings from the Global Burden of Disease Study","author":"A J Ferrari","year":"2016","journal-title":"Bipolar Disord"},{"key":"ref4","doi-asserted-by":"crossref","first-page":"212","DOI":"10.1192\/bjp.bp.112.113548","article-title":"Treatment in a specialised out-patient mood disorder clinic v. standard out-patient treatment in the early course of bipolar disorder: Randomised clinical trial","volume":"202","author":"L V Kessing","year":"2013","journal-title":"Br J Psychiatry"},{"key":"ref5","doi-asserted-by":"crossref","first-page":"283","DOI":"10.1016\/j.jad.2013.10.054","article-title":"Trends in pharmacotherapy in patients referred to a bipolar specialty clinic, 2000-2011","volume":"155","author":"F Hooshmand","year":"2014","journal-title":"J Affect Disord"},{"key":"ref6","doi-asserted-by":"crossref","first-page":"247","DOI":"10.4088\/JCP.13m08834","article-title":"Trends in office-based mental health care provided by psychiatrists and primary care physicians","volume":"75","author":"M Olfson","year":"2014","journal-title":"J Clin Psychiatry"},{"key":"ref7","doi-asserted-by":"crossref","first-page":"53","DOI":"10.1002\/wps.20298","article-title":"Lithium vs. valproate vs. olanzapine vs. quetiapine as maintenance monotherapy for bipolar disorder: A population-based UK cohort study using electronic health records","volume":"15","author":"J F Hayes","year":"2016","journal-title":"World Psychiatry"},{"key":"ref8","doi-asserted-by":"crossref","first-page":"155","DOI":"10.4306\/pi.2010.7.3.155","article-title":"Psychopharmacological treatment status in outpatients with bipolar disorder: A clinical survey in Germany","volume":"7","author":"A Quante","year":"2010","journal-title":"Psychiatry Investig"},{"key":"ref9","doi-asserted-by":"crossref","first-page":"112965","DOI":"10.1016\/j.psychres.2020.112965","article-title":"Drug treatment for patients with bipolar disorders in psychiatric practices in Germany in 2009 and 2018","volume":"289","author":"J Bohlken","year":"2020","journal-title":"Psychiatry Res"},{"key":"ref10","doi-asserted-by":"crossref","first-page":"e28725","DOI":"10.1371\/journal.pone.0028725","article-title":"Prescribing trends in bipolar disorder: Cohort study in the United Kingdom THIN primary care database 1995-2009","volume":"6","author":"J Hayes","year":"2011","journal-title":"PLoS One"},{"key":"ref11","doi-asserted-by":"crossref","first-page":"g5673","DOI":"10.1136\/bmj.g5673","article-title":"Assessment and management of bipolar disorder: Summary of updated NICE guidance","volume":"349","author":"T Kendall","year":"2014","journal-title":"BMJ"},{"key":"ref12","first-page":"216","article-title":"S3-Leitlinie Bipolare St\u00f6rungen\u20141. Update 2019: Was ist neu in der Pharmakotherapie? [German S3 guidelines on bipolar disorders-first update 2019: What is new in pharmacotherapy?]","volume":"91","author":"T Bschor","year":"2020","journal-title":"Nervenarzt"},{"key":"ref13","doi-asserted-by":"crossref","first-page":"9","DOI":"10.4088\/JCP.v61n0104","article-title":"The increasing use of polypharmacotherapy for refractory mood disorders: 22 years of study","volume":"61","author":"M A Frye","year":"2000","journal-title":"J Clin Psychiatry"},{"key":"ref14","doi-asserted-by":"crossref","first-page":"719","DOI":"10.2147\/NDT.S100846","article-title":"Prevalence and clinical features associated with bipolar disorder polypharmacy: A systematic review","volume":"12","author":"M Fornaro","year":"2016","journal-title":"Neuropsychiatr Dis Treat"},{"key":"ref15","doi-asserted-by":"crossref","first-page":"1545","DOI":"10.2147\/NDT.S166730","article-title":"Systematic literature review on patterns of pharmacological treatment and adherence among patients with bipolar disorder type I in the USA","volume":"14","author":"M Greene","year":"2018","journal-title":"Neuropsychiatr Dis Treat"},{"key":"ref16","doi-asserted-by":"crossref","first-page":"706","DOI":"10.1176\/appi.ajp.2020.19091000","article-title":"20-Year trends in the pharmacologic treatment of bipolar disorder by psychiatrists in outpatient care settings","volume":"177","author":"T G Rhee","year":"2020","journal-title":"Am J Psychiatry"},{"key":"ref17","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1186\/2194-7511-1-5","article-title":"Drug treatment patterns in bipolar disorder: Analysis of long-term self-reported data","volume":"1","author":"M Bauer","year":"2013","journal-title":"Int J Bipolar Disord"},{"key":"ref18","doi-asserted-by":"publisher","DOI":"10.1111\/bdi.12623.","article-title":"Effectiveness of maintenance therapy of lithium vs other mood stabilizers in monotherapy and in combinations: A systematic review of evidence from observational studies","author":"L V Kessing","year":"2018","journal-title":"Bipolar Disord"},{"key":"ref19","doi-asserted-by":"crossref","first-page":"459","DOI":"10.5414\/CP203320","article-title":"Basic characteristics and representativeness of the German Disease Analyzer database","volume":"56","author":"W Rathmann","year":"2018","journal-title":"Int J Clin Pharmacol Ther"},{"key":"ref20","doi-asserted-by":"crossref","first-page":"577","DOI":"10.3233\/JAD-190239","article-title":"Analysis of the effects of selective serotonin (and noradrenaline) reuptake inhibitors on the risk of dementia in patients with depression","volume":"62","author":"K Kostev","year":"2019","journal-title":"J Alzheimers Dis"},{"key":"ref22","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1186\/s40345-019-0145-0","article-title":"Controversies in bipolar disorder; role of second-generation antipsychotic for maintenance therapy","volume":"7","author":"S Jauhar","year":"2019","journal-title":"Int J Bipolar Disord"},{"key":"ref23","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1186\/s40345-018-0133-9","article-title":"Antidepressants in bipolar depression: An enduring controversy","volume":"6","author":"M J Gitlin","year":"2018","journal-title":"Int J Bipolar Disord"},{"key":"ref24","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1097\/YIC.0000000000000282","article-title":"Differential core pharmacotherapy in bipolar I versus bipolar II disorder and European versus American patients not in a syndromal episode","volume":"35","author":"B Dell\u2019Osso","year":"2020","journal-title":"Int Clin Psychopharmacol"},{"key":"ref25","doi-asserted-by":"crossref","first-page":"85","DOI":"10.1176\/ps.2007.58.1.85","article-title":"Patterns of psychotropic drug prescription for U.S. patients with diagnoses of bipolar disorders","volume":"58","author":"R J Baldessarini","year":"2007","journal-title":"Psychiatr Serv"},{"key":"ref26","doi-asserted-by":"crossref","first-page":"57","DOI":"10.1192\/bjp.bp.110.084822","article-title":"Valproate v. lithium in the treatment of bipolar disorder in clinical practice: observational nationwide register-based cohort study","volume":"199","author":"L V Kessing","year":"2011","journal-title":"Br J Psychiatry"},{"key":"ref27","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1016\/j.jad.2017.03.054","article-title":"Reducing the rehospitalization risk after a manic episode: A population based cohort study of lithium, valproate, olanzapine, quetiapine and aripiprazole in monotherapy and combinations","volume":"217","author":"L Wing\u00e5rd","year":"2017","journal-title":"J Affect Disord"},{"key":"ref28","doi-asserted-by":"crossref","first-page":"691","DOI":"10.1016\/j.euroneuro.2019.04.003","article-title":"Monotherapy vs. combination therapy for post mania maintenance treatment: A population based cohort study","volume":"29","author":"L Wing\u00e5rd","year":"2019","journal-title":"Eur Neuropsychopharmacol"},{"key":"ref29","doi-asserted-by":"crossref","first-page":"349","DOI":"10.1177\/2045125318804364","article-title":"Medication nonadherence in bipolar disorder: A narrative review","volume":"8","author":"I Jawad","year":"2018","journal-title":"Ther Adv Psychopharmacol"}],"container-title":["Pharmacopsychiatry"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/a-1348-1523.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,5,11]],"date-time":"2021-05-11T22:40:57Z","timestamp":1620772857000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/a-1348-1523"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,1,25]]},"references-count":28,"journal-issue":{"issue":"03","published-online":{"date-parts":[[2021,5,11]]},"published-print":{"date-parts":[[2021,5]]}},"URL":"https:\/\/doi.org\/10.1055\/a-1348-1523","relation":{},"ISSN":["0176-3679","1439-0795"],"issn-type":[{"value":"0176-3679","type":"print"},{"value":"1439-0795","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,1,25]]}}}