Evidence map›Paper›PMID 32312111›Full record

ArticleThe American journal of psychiatry2020

20-Year Trends in the Pharmacologic Treatment of Bipolar Disorder by Psychiatrists in Outpatient Care Settings.

Taeho Greg Rhee, Mark Olfson, Andrew A Nierenberg, Samuel T Wilkinson

Open access · bronzeAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in The American journal of psychiatry, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 87 papers, 6 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
87citing papers in PubMed, 6 pooled it
21.4field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

87 citing papers in PubMed, 6 syntheses or guidelines pooled it, 230 citations in OpenAlex.

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  14. Time to lithium: A case register study of lithium initiation in bipolar disorder.Journal of psychopharmacology (Oxford, England) · 2026
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27 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

4 authors at 1 institution in 1 country.

Taeho Greg RheeDepartment of Public Health Sciences, School of Medicine, University of Connecticut, Farmington (Rhee); Department of Psychiatry, School of Medicine, Yale University, New Haven, Conn. (Rhee, Wilkinson); Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York (Olfson); and Center for Bipolar Treatment Innovation, Massachusetts General Hospital, and Department of Psychiatry, Harvard Medical School, Harvard University, Boston (Nierenberg).
Mark OlfsonDepartment of Public Health Sciences, School of Medicine, University of Connecticut, Farmington (Rhee); Department of Psychiatry, School of Medicine, Yale University, New Haven, Conn. (Rhee, Wilkinson); Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York (Olfson); and Center for Bipolar Treatment Innovation, Massachusetts General Hospital, and Department of Psychiatry, Harvard Medical School, Harvard University, Boston (Nierenberg).
Andrew A NierenbergDepartment of Public Health Sciences, School of Medicine, University of Connecticut, Farmington (Rhee); Department of Psychiatry, School of Medicine, Yale University, New Haven, Conn. (Rhee, Wilkinson); Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York (Olfson); and Center for Bipolar Treatment Innovation, Massachusetts General Hospital, and Department of Psychiatry, Harvard Medical School, Harvard University, Boston (Nierenberg).
Samuel T WilkinsonDepartment of Public Health Sciences, School of Medicine, University of Connecticut, Farmington (Rhee); Department of Psychiatry, School of Medicine, Yale University, New Haven, Conn. (Rhee, Wilkinson); Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York (Olfson); and Center for Bipolar Treatment Innovation, Massachusetts General Hospital, and Department of Psychiatry, Harvard Medical School, Harvard University, Boston (Nierenberg).
Harvard University · US

Funding

Yale Clinical and Translational Science Award (U Component)UL1TR001863 · NCATS · YALE UNIVERSITY · PI John H. Krystal, LUCILA OHNO-MACHADO · 2016 to 2026
$102.9M
Yale Training Program in Geriatric Clinical Epidemiology and Aging-Related ResearchT32AG019134 · NIA · YALE UNIVERSITY · PI Terri R. Fried · 2001 to 2026
$7.5M
Improving the Emergency Department Management of Deliberate Self-HarmR01MH107452 · NIMH · UNIVERSITY OF PENNSYLVANIA · PI MARCUS, STEVEN C, OLFSON, MARK · 2016 to 2020
$4.3M
Yale-CORE Career Development Program in Patient-Centered Outcomes ResearchK12HS023000 · AHRQ · YALE UNIVERSITY · PI KRUMHOLZ, HARLAN MARC · 2014 to 2018
$3.4M
Towards a Comprehensive Developmental Model of Substance Use DisordersR01DA019606 · NIDA · NEW YORK STATE PSYCHIATRIC INSTITUTE DBA RESEARCH FOUNDATION FOR MENTAL HYGIENE, INC · PI OLFSON, MARK · 2006 to 2016
$2.6M
Health Care Policy and Substance Abuse Treatment AccessR01DA039137 · NIDA · COLUMBIA UNIVERSITY HEALTH SCIENCES · PI MOJTABAI, RAMIN, OLFSON, MARK · 2017 to 2022
$1.9M
AHRQ HHS K12 HS023000NCATS NIH HHS UL1 TR001863NIA NIH HHS T32 AG019134NIDA NIH HHS R01 DA019606NIDA NIH HHS R01 DA039137NIMH NIH HHS R01 MH107452
6 · The paper itself

Abstract

objectivePharmacological options for treating bipolar disorder have increased over the past 20 years, with several second-generation antipsychotics receiving regulatory approval in the 1990s. The authors describe trends in use of pharmacological agents in the outpatient management of bipolar disorder.

methodsUsing nationally representative data from the 1997-2016 National Ambulatory Medical Care Surveys, the authors examined trends in the use of mood stabilizers, first- and second-generation antipsychotics, and antidepressants among psychiatrist visits for which bipolar disorder was listed among the primary diagnoses. A logistic regression model was used to identify statistically significant trends, with covariates including age, gender, race/ethnicity, and primary insurance.

resultsAntipsychotics were increasingly more commonly prescribed, increasing from 12.4% of outpatient visits for bipolar disorder in the 1997-2000 period to 51.4% in the 2013-2016 period (adjusted odds ratio=5.05, 95% CI=3.65-7.01). Use of mood stabilizers decreased from 62.3% of visits for bipolar disorder in the 1997-2000 period to 26.4% in the 2013-2016 period (adjusted odds ratio=0.18, 95% CI=0.13-0.27). Prescription of antidepressants occurred in 47.0% of visits for bipolar disorder in the 1997-2000 period and 57.5% in the 2013-2016 period. Prescription of an antidepressant without a mood stabilizer increased substantially, from 17.9% in the 1997-2000 period to 40.9% in the 2013-2016 period (adjusted odds ratio=2.88, 95% CI=2.06-4.03).

conclusionsSubstantial changes have occurred in the treatment of bipolar disorder over the past 20 years, with second-generation antipsychotics in large measure supplanting traditional mood stabilizers. Antidepressant prescriptions persisted despite a lack of evidence for their efficacy in bipolar disorder and concerns about increasing the risk of mania. Research is needed to compare the real-world effectiveness and tolerability of newer antipsychotics with those of traditional mood stabilizers.

Indexed as

Bipolar DisorderPsychotropic DrugsAdultAge FactorsAmbulatory CareDrug UtilizationEthnicityFemaleHealth Care SurveysHumansMaleMental Health ServicesPractice Patterns, Physicians'PsychiatrySex FactorsUnited StatesPsychotropic DrugsAntipsychoticsBipolar DisorderLithiumOutpatient

Identifiers

PMID32312111
PMCPMC7577523
OpenAlexW3016987955

What OpenQuestion holds

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LicenceTDM
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.