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Lithium superior to valproate for suicide in bipolar disorder

Recent findings indicated that lithium, but not valproate, significantly reduced suicidal behavior among individuals with bipolar disorder.

“Patients with bipolar disorder have a high risk of suicidal behavior compared with both the general population and patients with other psychiatric disorders,” Jie Song, PhD, of Karolinska Institutet, Stockholm, and colleagues wrote. “Among the options of maintenance treatments for bipolar disorder, lithium is the first-line treatment and is suggested to have an antisuicidal effect. Valproate is a widely used alternative to lithium in preventing manic episodes and relapses, but its effect on suicidal behavior is unclear.”

To assess associations between lithium and valproate treatment with suicidal behavior in bipolar disorder, researchers used Swedish national register data to follow 51,535 individuals with bipolar disorder from 2005 to 2013 for treatment with lithium and valproate.

During follow-up, there were 10,648 suicide-related events.

Suicide incidence rates were significantly lower during lithium treatment (14%; HR = 0.86; 95% CI, 0.78-0.95), but not during valproate treatment (HR = 1.02; 95% CI, 0.89-1.15).

Estimates of population attributable fraction indicated 12% of suicide-related events may have been avoided if individuals received lithium during the entire follow-up.

“Our results, in conjunction with existing literature, indicate that in patients with bipolar disorder and suspected suicidal intentions, lithium should be considered as a suicide preventive strategy, with a balance between efficacy and tolerability,” the researchers concluded. – by Amanda Oldt

Disclosure: Song reports no relevant financial disclosures. Please see the study for a full list of relevant financial disclosures.