{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T21:39:53Z","timestamp":1790372393878,"version":"4.1.0"},"reference-count":39,"publisher":"Royal College of Psychiatrists","issue":"1","license":[{"start":{"date-parts":[[2018,1,2]],"date-time":"2018-01-02T00:00:00Z","timestamp":1514851200000},"content-version":"unspecified","delay-in-days":2377,"URL":"https:\/\/www.cambridge.org\/core\/terms"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Br J Psychiatry"],"published-print":{"date-parts":[[2011,7]]},"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Valproate is one of the most used mood stabilisers for bipolar disorder, although the evidence for the effectiveness of valproate is sparse.<\/jats:p><\/jats:sec><jats:sec><jats:title>Aims<\/jats:title><jats:p>To compare the effect of valproate<jats:italic>v.<\/jats:italic>lithium for treatment of bipolar disorder in clinical practice.<\/jats:p><\/jats:sec><jats:sec><jats:title>Method<\/jats:title><jats:p>An observational cohort study with linkage of nationwide registers of all people with a diagnosis of bipolar disorder in psychiatric hospital settings who were prescribed valproate or lithium in Denmark during a period from 1995 to 2006.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 4268 participants were included among whom 719 received valproate and 3549 received lithium subsequent to the diagnosis of bipolar disorder. The rate of switch\/add on to the opposite drug (lithium or valproate), antidepressants, antipsychotics or anticonvulsants (other than valproate) was increased for valproate compared with lithium (hazard ratio (HR) = 1.86, 95% CI 1.59\u20132.16). The rate of psychiatric hospital admissions was increased for valproate<jats:italic>v.<\/jats:italic>lithium (HR = 1.33, 95% CI 1.18\u20131.48) and regardless of the type of episode leading to a hospital admission (depressive or manic\/mixed). Similarly, for participants with a depressive index episode (HR = 1.87, 95% CI 1.40\u20132.48), a manic index episode (HR = 1.24, 95% CI 1.01\u20131.51) and a mixed index episode (HR = 1.44, 95% CI 1.04\u20132.01), the overall rate of hospital admissions was significantly increased for valproate compared with lithium.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>In daily clinical practice, treatment with lithium seems in general to be superior to treatment with valproate.<\/jats:p><\/jats:sec>","DOI":"10.1192\/bjp.bp.110.084822","type":"journal-article","created":{"date-parts":[[2011,5,19]],"date-time":"2011-05-19T05:05:15Z","timestamp":1305781515000},"page":"57-63","source":"Crossref","is-referenced-by-count":88,"title":["Valproate<i>v.<\/i>lithium in the treatment of bipolar disorder in clinical practice: observational nationwide register-based cohort study"],"prefix":"10.1192","volume":"199","author":[{"given":"Lars Vedel","family":"Kessing","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gunnar","family":"Hellmund","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John R.","family":"Geddes","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guy M.","family":"Goodwin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Per Kragh","family":"Andersen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"170","published-online":{"date-parts":[[2018,1,2]]},"reference":[{"key":"S0007125000255839_ref39","doi-asserted-by":"publisher","DOI":"10.1111\/j.1399-5618.2008.00464.x"},{"key":"S0007125000255839_ref37","doi-asserted-by":"publisher","DOI":"10.1176\/appi.ajp.162.10.1805"},{"key":"S0007125000255839_ref36","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(09)61970-X"},{"key":"S0007125000255839_ref34","doi-asserted-by":"publisher","DOI":"10.1176\/appi.ajp.159.3.469"},{"key":"S0007125000255839_ref31","doi-asserted-by":"publisher","DOI":"10.1080\/15622970902823202"},{"key":"S0007125000255839_ref30","doi-asserted-by":"publisher","DOI":"10.1111\/j.1399-5618.2009.00712.x"},{"key":"S0007125000255839_ref29","doi-asserted-by":"publisher","DOI":"10.1016\/S0924-977X(03)00078-6"},{"key":"S0007125000255839_ref28","doi-asserted-by":"publisher","DOI":"10.1034\/j.1600-0447.108.s419.1.x"},{"key":"S0007125000255839_ref27","doi-asserted-by":"crossref","DOI":"10.1111\/j.1943-278X.2000.tb00993.x","article-title":"Suicidal behavior and prophylactic lithium treatment of major mood disorders: a review of reviews","volume":"30","author":"Schou","year":"2000","journal-title":"Suicide Life Threat Behav"},{"key":"S0007125000255839_ref25","doi-asserted-by":"publisher","DOI":"10.1177\/070674370304800702"},{"key":"S0007125000255839_ref24","doi-asserted-by":"publisher","DOI":"10.1001\/archpsyc.62.8.860"},{"key":"S0007125000255839_ref22","volume-title":"Klassifikation af Sygdomme. 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