{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,22]],"date-time":"2026-07-22T17:38:37Z","timestamp":1784741917392,"version":"3.55.0"},"reference-count":44,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2026,2,16]],"date-time":"2026-02-16T00:00:00Z","timestamp":1771200000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,2,16]],"date-time":"2026-02-16T00:00:00Z","timestamp":1771200000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Bipolar Disorders"],"published-print":{"date-parts":[[2026,3]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Antidepressant (AD) use in bipolar I disorder (BD\u2010I) remains controversial due to concerns about inducing manic\/mixed episodes. We examined hospitalization risk following AD initiation in BD\u2010I patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Using electronic health records from Catalonia (2010\u20132019), we conducted a retrospective cohort study of 7946 BD\u2010I patients. We performed 1:1 propensity score matching based on age, sex, comorbidity count, and baseline mood stabilizer and antipsychotic use, yielding 3973\u2009AD users matched to 3973 controls (mean age 50.9\u2009years, 47.3% female) with 12\u2010month follow\u2010up. AD users were categorized by treatment strategy: AD monotherapy, AD plus antipsychotic (AD\u2009+\u2009AP), AD plus mood stabilizer (AD\u2009+\u2009MS), and AD plus both (AD\u2009+\u2009MS\u2009+\u2009AP). We estimated hospitalization risk using Cox proportional hazards models adjusted for clinical and demographic factors.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      During follow\u2010up, 6.3% of patients experienced manic\/mixed episode hospitalization. Overall, AD use was associated with increased risk (HR\u2009=\u20091.27,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.008), with AD monotherapy showing highest risk (HR\u2009=\u20091.51,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). Notably, AD\u2009+\u2009MS combinations showed no significant risk increase. All AD strategies were associated with substantially higher risk for mixed episodes compared to pure mania. Age significantly modified risk, with patients 18\u201335\u2009years showing greatest vulnerability to AD monotherapy (HR\u2009=\u20092.36,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In BD\u2010I, AD use increases manic\/mixed episode hospitalization risk by approximately 30%, with differential effects across treatment strategies and patient subgroups. Combining ADs with mood stabilizers appears to mitigate this risk, while mixed episodes and younger age represent particularly high\u2010risk scenarios. These findings support guideline recommendations against AD monotherapy while suggesting opportunities for personalized treatment approaches in BD\u2010I.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/bdi.70088","type":"journal-article","created":{"date-parts":[[2026,2,17]],"date-time":"2026-02-17T05:59:46Z","timestamp":1771307986000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Antidepressant\u2010Associated Risk of Manic and Mixed Episode Hospitalization in Bipolar I Disorder: A 10\u2010Year Population\u2010Based Cohort Study"],"prefix":"10.1111","volume":"28","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2693-6849","authenticated-orcid":false,"given":"Diego","family":"Hidalgo\u2010Mazzei","sequence":"first","affiliation":[{"name":"Department of Psychiatry and Psychology Hospital Cl\u00ednic de Barcelona  Barcelona Catalonia Spain"},{"name":"Bipolar and Depressive Disorders Unit, Institut d'Investigacions Biom\u00e8diques August Pi I Sunyer (IDIBAPS), Catalonia  Barcelona Catalonia Spain"},{"name":"Biomedical Research Networking Centre Consortium on Mental Health (CIBERSAM), Instituto de Salud Carlos III  Madrid Spain"},{"name":"Department of Medicine School of Medicine and Health Sciences, Institute of Neurosciences (UBNeuro), University of Barcelona (UB)  Catalonia Barcelona Spain"},{"name":"Centre for Affective Disorders (CfAD), Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6798-4054","authenticated-orcid":false,"given":"Gerard","family":"Anmella","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Psychology Hospital Cl\u00ednic de Barcelona  Barcelona Catalonia Spain"},{"name":"Bipolar and Depressive Disorders Unit, Institut d'Investigacions Biom\u00e8diques August Pi I Sunyer (IDIBAPS), Catalonia  Barcelona Catalonia Spain"},{"name":"Biomedical Research Networking Centre Consortium on Mental Health (CIBERSAM), Instituto de Salud Carlos III  Madrid Spain"},{"name":"Department of Medicine School of Medicine and Health Sciences, Institute of Neurosciences (UBNeuro), University of Barcelona (UB)  Catalonia Barcelona Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2032-1181","authenticated-orcid":false,"given":"Michele","family":"De Prisco","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Psychology Hospital Cl\u00ednic de Barcelona  Barcelona Catalonia Spain"},{"name":"Bipolar and Depressive Disorders Unit, Institut d'Investigacions Biom\u00e8diques August Pi I Sunyer (IDIBAPS), Catalonia  Barcelona Catalonia Spain"},{"name":"Biomedical Research Networking Centre Consortium on Mental Health (CIBERSAM), Instituto de Salud Carlos III  Madrid Spain"},{"name":"Department of Medicine School of Medicine and Health Sciences, Institute of Neurosciences (UBNeuro), University of Barcelona (UB)  Catalonia Barcelona Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5961-6032","authenticated-orcid":false,"given":"Vincenzo","family":"Oliva","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Psychology Hospital Cl\u00ednic de Barcelona  Barcelona Catalonia Spain"},{"name":"Bipolar and Depressive Disorders Unit, Institut d'Investigacions Biom\u00e8diques August Pi I Sunyer (IDIBAPS), Catalonia  Barcelona Catalonia Spain"},{"name":"Biomedical Research Networking Centre Consortium on Mental Health (CIBERSAM), Instituto de Salud Carlos III  Madrid Spain"},{"name":"Department of Medicine School of Medicine and Health Sciences, Institute of Neurosciences (UBNeuro), University of Barcelona (UB)  Catalonia Barcelona 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