{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T08:14:47Z","timestamp":1777536887948,"version":"3.51.4"},"reference-count":38,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2018,6,19]],"date-time":"2018-06-19T00:00:00Z","timestamp":1529366400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/100006093","name":"Patient-Centered Outcomes Research Institute","doi-asserted-by":"publisher","award":["CER\u20101507\u20103160"],"award-info":[{"award-number":["CER\u20101507\u20103160"]}],"id":[{"id":"10.13039\/100006093","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Bipolar Disorders"],"published-print":{"date-parts":[[2018,12]]},"abstract":"<jats:sec><jats:title>Objectives<\/jats:title><jats:p>This study compared 29 drugs for risk of psychiatric hospitalization in bipolar disorders, addressing the evidence gap on the &gt;50 drugs used by <jats:styled-content style=\"fixed-case\">US<\/jats:styled-content> patients for treatment.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>The Truven Health Analytics MarketScan<jats:sup>\u00ae<\/jats:sup> database was used to identify 190\u00a0894 individuals with bipolar or schizoaffective disorder who filled a prescription for one of 29 drugs of interest: lithium, first\u2010 or second\u2010generation antipsychotics, mood\u2010stabilizing anticonvulsants, and antidepressants. Competing risks regression survival analysis was used to compare drugs for risk of psychiatric hospitalization, adjusting for patient age, sex, comorbidities, and pretreatment medications. Other competing risks were ending monotherapy and non\u2010psychiatric hospitalization.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Three drugs were associated with significantly lower risk of psychiatric hospitalization than lithium: valproate (relative risk [<jats:styled-content style=\"fixed-case\">RR<\/jats:styled-content>]\u00a0=\u00a00.80, <jats:italic>P<\/jats:italic>\u00a0=\u00a03.20\u00a0\u00d7\u00a010<jats:sup>\u22124<\/jats:sup>), aripiprazole (<jats:styled-content style=\"fixed-case\">RR<\/jats:styled-content>\u00a0=\u00a00.80, <jats:italic>P<\/jats:italic>\u00a0=\u00a03.50\u00a0\u00d7\u00a010<jats:sup>\u22124<\/jats:sup>), and bupropion (<jats:styled-content style=\"fixed-case\">RR<\/jats:styled-content>\u00a0=\u00a00.80, <jats:italic>P<\/jats:italic>\u00a0=\u00a02.80\u00a0\u00d7\u00a010<jats:sup>\u22124<\/jats:sup>). Eight drugs were associated with significantly higher risk of psychiatric hospitalization: haloperidol (<jats:styled-content style=\"fixed-case\">RR<\/jats:styled-content>\u00a0=\u00a01.57, <jats:italic>P<\/jats:italic>\u00a0=\u00a09.40\u00a0\u00d7\u00a010<jats:sup>\u22124<\/jats:sup>), clozapine (<jats:styled-content style=\"fixed-case\">RR<\/jats:styled-content>\u00a0=\u00a01.52, <jats:italic>P<\/jats:italic>\u00a0=\u00a0.017), fluoxetine (<jats:styled-content style=\"fixed-case\">RR<\/jats:styled-content>\u00a0=\u00a01.17, <jats:italic>P<\/jats:italic>\u00a0=\u00a03.70\u00a0\u00d7\u00a010<jats:sup>\u22123<\/jats:sup>), sertraline (<jats:styled-content style=\"fixed-case\">RR<\/jats:styled-content>\u00a0=\u00a01.17, <jats:italic>P<\/jats:italic>\u00a0=\u00a03.20\u00a0\u00d7\u00a010<jats:sup>\u22123<\/jats:sup>), citalopram (<jats:styled-content style=\"fixed-case\">RR<\/jats:styled-content>\u00a0=\u00a01.14, <jats:italic>P<\/jats:italic>\u00a0=\u00a0.013), duloxetine (<jats:styled-content style=\"fixed-case\">RR<\/jats:styled-content> =\u00a01.24, <jats:italic>P<\/jats:italic>\u00a0=\u00a05.10\u00a0\u00d7\u00a010<jats:sup>\u22124<\/jats:sup>), venlafaxine (<jats:styled-content style=\"fixed-case\">RR<\/jats:styled-content>\u00a0=\u00a01.33; <jats:italic>P<\/jats:italic>\u00a0=\u00a01.00\u00a0\u00d7\u00a010<jats:sup>\u22126<\/jats:sup>), and ziprasidone (<jats:styled-content style=\"fixed-case\">RR<\/jats:styled-content>\u00a0=\u00a01.25; <jats:italic>P<\/jats:italic>\u00a0=\u00a06.20\u00a0\u00d7\u00a010<jats:sup>\u22123<\/jats:sup>).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>This largest reported retrospective observational study on bipolar disorders pharmacotherapy to date demonstrates that the majority of patients end monotherapy within 2\u00a0months after treatment start. The risk of psychiatric hospitalization varied almost two\u2010fold across individual medications. The data add to the evidence favoring lithium and mood stabilizer use in short\u2010term bipolar disorder management. The findings that the dopaminergic drugs aripiprazole and bupropion had better outcomes than other members of their respective classes and that antidepressant outcomes may vary by baseline mood polarity merit further investigation.<\/jats:p><\/jats:sec>","DOI":"10.1111\/bdi.12665","type":"journal-article","created":{"date-parts":[[2018,6,19]],"date-time":"2018-06-19T16:58:20Z","timestamp":1529427500000},"page":"761-771","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Comprehensive comparison of monotherapies for psychiatric hospitalization risk in bipolar disorders"],"prefix":"10.1111","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5558-2381","authenticated-orcid":false,"given":"Anastasiya","family":"Nestsiarovich","sequence":"first","affiliation":[{"name":"Center for Global Health Department of Internal Medicine University of New Mexico Health Sciences Center  Albuquerque NM, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aur\u00e9lien J","family":"Mazurie","sequence":"additional","affiliation":[{"name":"TwoFoldChange Consulting  Bozeman MT, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nathaniel G","family":"Hurwitz","sequence":"additional","affiliation":[{"name":"New Mexico Behavioral Health Institute  Las Vegas NM, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Berit","family":"Kerner","sequence":"additional","affiliation":[{"name":"Semel Institute for Neuroscience and Human Behavior David Geffen School of Medicine University of California  Los Angeles CA, USA"},{"name":"Witten\/Herdecke University  Witten Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stuart J","family":"Nelson","sequence":"additional","affiliation":[{"name":"University of New Mexico Health Sciences Library and Informatics Center  Albuquerque NM, USA"},{"name":"Division of Translational Informatics Department of Internal Medicine University of New Mexico Health Sciences Center  Albuquerque NM, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Annette S","family":"Crisanti","sequence":"additional","affiliation":[{"name":"Department of Psychiatry &amp; Behavioral Sciences University of New Mexico Health Sciences Center  Albuquerque NM, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8049-4351","authenticated-orcid":false,"given":"Mauricio","family":"Tohen","sequence":"additional","affiliation":[{"name":"Department of Psychiatry &amp; Behavioral Sciences University of New Mexico Health Sciences Center  Albuquerque NM, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ronald L","family":"Krall","sequence":"additional","affiliation":[{"name":"University of Pittsburgh School of Medicine  Pittsburgh PA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Douglas 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