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Our objective was to study the incidence of, and predictors for, long\u2010term use of benzodiazepines and Z\u2010drugs in bipolar disorder.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We conducted a population\u2010based cohort study, using data from Swedish national registers. Swedish residents aged 18\u201075 years with a recorded diagnosis of bipolar disorder or mania between July 2006 and December 2012, and no history of benzodiazepine\/Z\u2010drug use in the past year, were included. Patients were followed for 1\u00a0year with regard to prescription fills of benzodiazepines\/Z\u2010drugs. Initiators were followed for another year during which continuous use for &gt;6\u00a0months was defined as \u201clong\u2010term\u201d. Patient and prescription characteristics were investigated as potential predictors for long\u2010term use in multivariate logistic regression models.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Out of the 21\u00a0883 patients included, 29% started benzodiazepine\/Z\u2010drug treatment, of whom one in five became long\u2010term users. Patients who were prescribed clonazepam or alprazolam had high odds for subsequent long\u2010term use (adjusted odds ratios [<jats:styled-content style=\"fixed-case\">aOR<\/jats:styled-content>s] 3.78 [95% confidence interval (<jats:styled-content style=\"fixed-case\">CI)<\/jats:styled-content> 2.24\u20106.38] and 2.03 [95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> 1.30\u20103.18], respectively), compared to those prescribed diazepam. Polytherapy with benzodiazepines\/Z\u2010drugs also predicted long\u2010term use (<jats:styled-content style=\"fixed-case\">aOR<\/jats:styled-content> 2.46, 95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> 1.79\u20103.38), as did age \u226560\u00a0years (<jats:styled-content style=\"fixed-case\">aOR<\/jats:styled-content> 1.93, 95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> 1.46\u20102.53, compared to age &lt;30\u00a0years), and concomitant treatment with psychostimulants (<jats:styled-content style=\"fixed-case\">aOR<\/jats:styled-content> 1.78, 95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> 1.33\u20102.39).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The incidence of subsequent long\u2010term use among bipolar benzodiazepine initiators is high. Patients on clonazepam, alprazolam or benzodiazepine\/Z\u2010drug polytherapy have the highest risk of becoming long\u2010term users, suggesting that these treatments should be used restrictively.<\/jats:p><\/jats:sec>","DOI":"10.1111\/bdi.12626","type":"journal-article","created":{"date-parts":[[2018,2,16]],"date-time":"2018-02-16T05:12:46Z","timestamp":1518757966000},"page":"634-646","source":"Crossref","is-referenced-by-count":25,"title":["Initiation and long\u2010term use of benzodiazepines and Z\u2010drugs in bipolar disorder"],"prefix":"10.1111","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6618-539X","authenticated-orcid":false,"given":"Louise","family":"Wing\u00e5rd","sequence":"first","affiliation":[{"name":"Centre for Pharmacoepidemiology (CPE) Department of Medicine, Solna Karolinska Institutet Karolinska University Hospital  Stockholm 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