The estimated lifetime risk of suic...

The estimated lifetime risk of suicide in individuals with bipolar disorder ranges from 8 to 20 percent a rate that is 10 to 20 times the rate in the U general population. Lithium and the anticonvulsant agent lamotrigine are the single drugs for which long-term efficacy in the treatment of bipolar disorder has been reliably established. Suicide rates in patients taking lithium have been shown to be lower than rates in patients not taking lithium. Nonetheless, lithium use in the United States had declined across recent years in favor of anticonvulsant agents, including divalproex. In this thought Goodwin and colleagues examined the risk of attempted and complet suicide in patients treated for bipolar disorder, to identify, among other things, periods of in all senses to lithium, divalproex, and carbamazepine.

Participants in this retrospective cohort research included those 14 years or older with a record of outpatient treatment for bipolar disorder, who filled at least individual prescription for lithium, divalproex, or carbamazepine during the research period. Outcome measures were suicide attempts requiring or not requiring hospitalization and suicide deaths. Treatment position was estimated on the basis of prescriptions filled, and confounding factors considered included a variety of organic diseases and mental health disorders that could have influenced the risk of suicide or the choice of vein stabilizer prescribed.

The authors identified 20638 health plan members who fit the study's inclusion and exclusion criteria. There were 53 suicides, 338 attempts resulting in hospitalization, and 642 attempts identified in turn of events departments. Groups were subdivided into patients with no exposing to the studied drugs, patients expos to lithium alone, to divalproex alone, to carbamazepine alone, or to a combination of these agents.

For all issues measured, rates of suicide and suicide attempts were substantially greater when patients were expos to divalproex than to lithium; hazard ratios were 27 17 and 18 for suicide death, attempt resulting in hospitalization, and attempt ascertained in the turn of events department, respectively. Risks were also considerably higher, at 22 16 and 14 for these three results when patients taking no humor stabilizers were compared with those taking lithium alone.

Overall, the risk of suicide attempt or suicide death was single in kind and one half to three times higher in patients treated with divalproex than with lithium. This finding held plane after controlling for characteristics that might indicate greater severity of illness or suicide risk and thus influence prescription choice. The authors emphasize that further research is wanted to determine whether suicide risk is also lowered with lithium-anticonvulsant combinations, because the number of patients using combination treatment in this inquiry was too small to allow accurate estimation of suicide risk for that subgroup existing prescribing patterns, which have mov away from lithium in late years, should be reevaluated.

Goodwin FK et al. Suicide risk in bipolar disorder during treatment with lithium and divalproex. JAMA September 17 2003;290:1467-73

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