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This study examines the trajectories of psychotropic drug use and polypsychopharmacy in psychiatric inpatients with acute BD-DE.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Using data from the German pharmacovigilance program \u201cArzneimittelsicherheit in der Psychiatrie\u201d (AMSP), the pharmacological treatment of 1,902 psychiatric inpatients with BD-DE between 2007\u20132024 was analyzed. Temporal changes in drug use between early (T1: 2007\u20132010) and late (T2: 2021\u20132024) periods were calculated using prevalence ratios (PR) with 95% confidence intervals (CI) and Welch\u2019s t-test.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Overall, 98.5% of inpatients with acute BD-DE were treated with psychotropic drugs. Antipsychotic drugs (APD) were the most used psychotropic drug group (76.2%), followed by antidepressant (ADD; 70.3%) and antiepileptic drugs (AED; 44.3%) during the entire study period. Over time, APD use increased from 70.1% in T1 to 80.7% in T2 (PR 1.15, CI 1.06\u20131.25), attributable to the increased use of second-generation APD (PR 1.19, CI 1.07\u20131.32), especially quetiapine and aripiprazole. ADD (T1: 78.1% vs T2: 67.6%; PR 0.87, CI 0.79\u20130.95) and AED (T1: 56.7% vs T2: 34.6%; PR 0.61, CI 0.51\u20130.73) use significantly declined, while lithium use remained stable (31.7% from 2007\u20132024). Although the mean number of psychotropic drugs per patient decreased (T1: 3.85 vs T2: 3.34,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001,\n                      <jats:italic>d<\/jats:italic>\n                      =\u22120.30), complex polypsychopharmacy consisting of \u22653 psychotropic drugs remained prevalent (66.1% of patients during the entire study period). Combination strategies involving APD, especially use of two APD, significantly increased (T1: 15.6% vs T2: 31.5%; PR 2.01, CI 1.51\u20132.69).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Pharmacological treatment of BD-DE has shifted towards an increased use of second-generation APD while AED are less utilized. ADD use and complex polypsychopharmacy continue to be prevalent, indicating a persistent gap between guideline recommendations and real-world practice.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s40345-026-00435-9","type":"journal-article","created":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T12:27:37Z","timestamp":1785500857000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Trajectories of psychotropic drug use patterns in psychiatric inpatients with acute depressive episodes of bipolar disorder: results from a pharmacovigilance program in German-speaking countries from 2007 to 2024"],"prefix":"10.1186","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8678-7419","authenticated-orcid":false,"given":"Johanna","family":"Seifert","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4734-1198","authenticated-orcid":false,"given":"Susanne","family":"St\u00fcbner","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-4858-0602","authenticated-orcid":false,"given":"Dominik","family":"Dabbert","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2342-735X","authenticated-orcid":false,"given":"Waldemar","family":"Greil","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2368-1235","authenticated-orcid":false,"given":"Hannah B.","family":"Maier","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Renate","family":"Grohmann","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8859-6907","authenticated-orcid":false,"given":"Sermin","family":"Toto","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,7,31]]},"reference":[{"issue":"2","key":"435_CR1","doi-asserted-by":"publisher","first-page":"345","DOI":"10.1517\/14740338.4.2.345","volume":"4","author":"R Alsdorf","year":"2005","unstructured":"Alsdorf R, Wyszynski DF. 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This study adheres to the Declaration of Helsinki and its later amendments. Due to its observational nature, AMSP does not interfere with the ongoing treatment of the patients under surveillance.","order":1,"name":"Ethics","label":"Ethics approval","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Not applicable.","order":2,"name":"Ethics","label":"Consent to participate","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Not applicable.","order":3,"name":"Ethics","label":"Consent for publication","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"RG, JS and ST are currently or have been project managers of the AMSP program. ST is a member of the advisory board for Otsuka Pharma GmbH and Johnson & Johnson Innovative Medicine and has received speaker\u00b4s honoraria from Johnson & Johnson Innovative Medicine, Lundbeck GmbH\/Otsuka Pharma GmbH, Recordati Pharma GmbH and ROVI GmbH. DD has received speaker\u2019s honoraria from Aristo Pharma. All other authors state they have no conflicts of interest to declare. The research presented in this manuscript did not receive any specific grants or funding. The AMSP drug safety project is facilitated by non-profit associations in Germany, Austria, and Switzerland. The AMSP project has been supported with unrestricted educational and research grants since 1993 by the following companies: German companies: Abbott GmbH & Co. KG, Aristo Pharma, AstraZeneca GmbH, Aventis Pharma Deutschland GmbH GE\u2013O\/R\/N, Bayer Vital GmbH, Boehringer Mannheim GmbH, Bristol-Myers-Squibb, Ciba Geigy GmbH, Desitin Arzneimittel GmbH, Duphar Pharma GmbH & Co. KG, Eisai GmbH, Esparma GmbH Arzneimittel, GlaxoSmithKline Pharma GmbH & Co. KG, Hoffmann-La Roche AG Medical Affairs, Janssen-Cilag GmbH, Janssen Research Foundation, Knoll Deutschland GmbH, Lilly Deutschland GmbH Niederlassung Bad Homburg, Lundbeck GmbH & Co. KG, Novartis Pharma GmbH, Nordmark Arzneimittel GmbH, Organon GmbH, Otsuka-Pharma Frankfurt, Pfizer GmbH, Pharmacia & Upjohn GmbH, Promonta Lundbeck Arzneimittel, Recordati Pharma GmbH, Rhone-Poulenc Rohrer, ROVI GmbH, Sanofi-Synthelabo GmbH, Sanofi-Aventis Deutschland, Schering AG, SmithKlineBeecham Pharma GmbH, Solvay Arzneimittel GmbH, Synthelabo Arzneimittel GmbH, Dr. Wilmar Schwabe GmbH & Co., Thiemann Arzneimittel GmbH, Troponwerke GmbH & Co. KG, Upjohn GmbH, Wander Pharma GmbH and Wyeth-Pharma GmbH. Austrian companies: Astra Zeneca \u00d6sterreich GmbH, Boehringer Ingelheim Austria, Bristol-Myers Squibb GmbH, CSC Pharmaceuticals GmbH, Eli Lilly GmbH, Germania Pharma GmbH, GlaxoSmithKline Pharma GmbH, Janssen-Cilag Pharma GmbH, Lundbeck GmbH, Novartis Pharma GmbH, Pfizer Med Inform and Wyeth Lederle Pharma GmbH. Swiss companies: AHP (Schweiz) AG, AstraZeneca AG, Bristol-Myers Squibb AG, Desitin Pharma GmbH, Eli Lilly (Suisse) S.A., Essex Chemie AG, GlaxoSmithKline AG, Janssen-Cilag AG, Lundbeck (Suisse) AG, Organon AG, Pfizer AG, Pharmacia, Sanofi-Aventis (Suisse) S.A., Sanofi-Synthelabo SA, Servier SA, SmithKlineBeecham AG, Solvay Pharma AG, Wyeth AHP (Suisse) AG and Wyeth Pharmaceuticals AG.","order":4,"name":"Ethics","label":"Competing interests","group":{"name":"EthicsHeading","label":"Declarations"}}],"article-number":"28"}}