Which Drugs Offer Lowest Risk of Bipolar Rehospitalization?

A girl balances on the rail of the train tracks. There are hills in the distance.People with bipolar who seek care in a psychiatric hospital may need to be hospitalized again if their symptoms get worse. Hospitalization can be disruptive to families and careers. It is also expensive, and it may not be fully covered by health insurance.

A large study of Finnish patients published in JAMA Psychiatry analyzed which medications were most effective at preventing rehospitalization. They studied antipsychotics, mood stabilizers, and anti-anxiety medications. Lithium, a mineral with mood-stabilizing effects, had the highest effectiveness.

Reducing the Risk of Bipolar Rehospitalization

The cohort study followed 18,018 Finnish people hospitalized for bipolar between 1987 and 2012. The data came from national databases of hospitalizations and medications. Researchers followed participants for an average of 7.2 years.

Over half (54%) of participants were hospitalized a second time during the follow-up period.

The researchers adjusted for factors linked to subsequent hospitalizations for bipolar. Then they assessed the correlation between rehospitalization and the use of various drugs. The study authors included rehospitalizations for both psychiatric and non-psychiatric reasons.

  • Lithium use was linked to the lowest risk of rehospitalization.
  • Within the class of antipsychotic drugs, gabapentin, risperidone injections, and perphenazine injections also reduced the risk.
  • Quetiapine fumarate was the most popular antipsychotic treatment, but its effects on rehospitalization risk were modest.
  • Benzodiazepines (a popular class of anti-anxiety drugs) were linked with an increased risk of rehospitalization.

For the class of antipsychotic drugs, the form of the medication also made a difference. People who took long-acting injections were 30% less likely to be readmitted to a psychiatric hospital than those who took antipsychotics in oral form. This held true even when people were taking the type of medication.

The study authors suggest lithium may be the best first-line treatment for bipolar. If someone cannot take lithium, long-acting antipsychotic injections may be a safe alternative. However, the authors admit more research is needed, since the study only analyzed Finnish individuals.


  1. Lahteenvuo, M., Tanskanen, A., Taipale, H., Hoti, F., Vattulainen, P., Vieta, E., & Tiihonen, J. (2018, February 28). Real-world effectiveness of pharmacologic treatments for the prevention of rehospitalization in a Finnish nationwide cohort of patients with bipolar disorder. JAMA Psychiatry. doi:10.1001/jamapsychiatry.2017.4711
  2. Lithium, injectable antipsychotics most effective at preventing rehospitalization for bipolar disorder in Finland. (2018, March 1). Retrieved from https://www.healio.com/psychiatry/bipolar-disorder/news/online/%7B3ea451cb-8b83-44c0-8246-b8317ebb92ee%7D/lithium-injectable-antipsychotics-most-effective-at-preventing-rehospitalization-for-bipolar-disorder-in-finland

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