Suicide risk in bipolar disorder lower with lithium than valproate
The risk of suicide among patients treated for bipolar disorder is lower during treatment with lithium than with valproate semisodium (valproic acid, Depakote), say researchers from the United States.
Dr Frederick Goodwin, George Washington University medical centre, Washington
DC, and colleagues point out that lithium use in bipolar disorder has
declined in the US over the past decade and that use of anticonvulsants,
such as valproic acid, has increased. And while there is evidence to
support the anti-suicide effects of lithium, few studies have addressed
the effects of anticonvulsants on suicide risk, they say.
They therefore compared the risk of suicide attempt and suicide death
among 20,638 patients with bipolar disorder. Patients were 1.5 to three
times more likely to attempt suicide or to die from a suicide attempt
during periods of treatment with valproic acid (known as divalproex in
the US) than during periods of treatment with lithium.
The researchers say their findings are consistent with previous data
suggesting lithium reduces suicide attempts and suicide mortality. “If
lithium does have an anti-suicide effect not matched by currently available
alternatives, then current prescribing patterns should be re-evaluated,” they
conclude (JAMA 2003;290:1467). |
