The ability of lithium and other mood stabilizers to decrease suicide risk and prevent relapse
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Bipolar disorder is marked by frequent recurrences, a course from childhood or early adulthood until death, marked increased rates of suicide, and substantial functional morbidity. Maintenance treatment is generally recommended to reduce the ravages of the illness. This article reviews the evidence that lithium, divalproex, and carbamazepine may reduce suicidal risk. It reviews the evidence for relapse prevention for lithium, valproate, and other drugs often employed in the maintenance phase treatment of bipolar disorder. Both lithium and divalproex appear beneficial in prevention of relapse, although recent studies indicate more modest effects for lithium than did early studies from the 1970s.
KeywordsLithium Bipolar Disorder Carbamazepine Valproate Suicidal Behavior
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References and Recommended Reading
- 5.Ahrens B, Müller-Oerlinghausen B, Grof P: Length of lithium treatment needed to eliminate the high mortality of affective disorders. Br J Psychiatry 1993, 163 Suppl 21:27–29.Google Scholar
- 9.Theis-Flechtner K, Müller-Oerlinghausen B, Seibert W, et al.: Effect of prophylactic treatment on suicide risk in patients with major affective disorders. Data from a randomized prospective trial. Pharmacopsychiatry 1996, 29:103–107.Google Scholar
- 13.Bowden CL, Calabrese JR, McElroy SL, et al.: A randomized, placebo-controlled 12-month trial of divalproex and lithium in treatment of outpatients with bipolar I disorder. Arch Gen Psychiatry 2000, 57:481–489. A large (n = 372) randomized study that provides the only blinded comparison of lithium with a mood stabilizer, and the only study to taper the mood stabilizer taken at the time of randomization, to reduce possibility of drug withdrawal-induced relapse.PubMedCrossRefGoogle Scholar
- 23.Maj M, Pirozzi R, Magliano L, Bartoli L: Long-term outcome of lithium prophylaxis in bipolar disorder: a 5-year prospective study of 402 patients at a lithium clinic. Am J Psychiatry 1998, 155:30–35. A systematic report of long-term outcomes with lithium treatment of bipolar disorder. It indicates good results among patients who stay with treatment for several years, but high rates of early failure, poor adherence, and dropouts.PubMedGoogle Scholar
- 25.Maggs R: Treatment of manic illness with lithium carbonate. Br J Psychiatry 1963, 109:56–65.Google Scholar
- 32.Lambert PA, Venaud D: Comparative study of valpromide versus lithium as prophylactic treatment in affective disorders. Nervure 1992, 5:57–65.Google Scholar
- 35.Baldessarini RJ, Tohen M, Tondo L: Maintenance treatment in bipolar disorder [comment]. Arch Gen Psychiatry 2000, 57:490–492. A thoughtful editorial on the complexities of analysis of treatments for prophylaxis of bipolar disorder, with special attention to the difficulties of studying a sample fully representative of the spectrum of bipolar disorder.PubMedCrossRefGoogle Scholar