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Yang JH, Park CHK, Rhee SJ, Kang DH, Kim MJ, Lee HJ, Lee SY, Shim SH, Moon JJ, Cho SJ, Kim SG, Kim MH, Lee J, Kang WS, Yoo J, Lee WY, Ahn YM. Psychotropic Medications Promote Time-Dependent Reduction of Suicidal Ideation in Mood Disorder: A Prospective Cohort Study. J Korean Med Sci 2024; 39:e226. [PMID: 39137811 PMCID: PMC11319105 DOI: 10.3346/jkms.2024.39.e226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Accepted: 06/24/2024] [Indexed: 08/15/2024] Open
Abstract
BACKGROUND Despite a plethora of research on the topic, there is still no solid evidence that pharmacological treatment actually reduces the risk of suicide in patients with mental illness. In this study, we aimed to assess the effect of psychotropic medications on suicidal ideation in patients with major depressive disorder (MDD) and bipolar disorder (BPD) in two age groups: less than 25 years and 25 years and older. METHODS We analyzed 312 patients with mood disorders with current suicidal thoughts or recent suicide attempts. We followed the participants from baseline for 6 months and assessed changes in suicidal ideation with Columbia-Suicide Severity Rating Scale (C-SSRS). The effect of psychotropic drug administration on suicidal ideation over time was analyzed using a linear mixed model. RESULTS In patients aged 25 years and older with mood disorders, suicidal ideation was more severe when using psychotropic drugs than when not using them. However, suicidal ideation decreased rapidly over time. The time-dependent reduction in suicidal ideation was accelerated when using antidepressants and sedatives/hypnotics in adult MDD, and when using mood stabilizers in adult BPD. However, this effect was not observed in participants aged less than 25 years. CONCLUSION Adequate psychotropic medication may reduce suicidal ideation in patients with mood disorders aged 25 years and older. Additional research on psychotropic drugs is needed to effectively reduce the risk of suicide among children and adolescents with mood disorders.
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Affiliation(s)
- Jeong Hun Yang
- Department of Psychiatry, Chungnam National University Sejong Hospital, Sejong, Korea
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Korea
| | | | - Sang Jin Rhee
- Department of Neuropsychiatry, Seoul National University Hospital, Seoul, Korea
| | - Dae Hun Kang
- Department of Neuropsychiatry, Seoul National University Hospital, Seoul, Korea
| | - Min Ji Kim
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Korea
| | - Hyun Jeong Lee
- Cancer Survivorship Branch, National Cancer Control Institute, National Cancer Center, Goyang, Korea
- Department of Psychiatry and Behavioral Science, National Cancer Center, Goyang, Korea
| | - Sang Yeol Lee
- Department of Psychiatry, Wonkwang University Hospital, Iksan, Korea
| | - Se-Hoon Shim
- Department of Psychiatry, Soon Chun Hyang University Cheonan Hospital, Soon Chun Hyang University, Cheonan, Korea
| | - Jung-Joon Moon
- Department of Psychiatry, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Seong-Jin Cho
- Department of Psychiatry, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Shin Gyeom Kim
- Department of Neuropsychiatry, Soon Chun Hyang University Bucheon Hospital, Bucheon, Korea
| | - Min-Hyuk Kim
- Department of Psychiatry, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Jinhee Lee
- Department of Psychiatry, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Won Sub Kang
- Department of Psychiatry, Kyung Hee University Hospital, Seoul, Korea
| | - Jieun Yoo
- College of Social Sciences, Yonsei University, Seoul, Korea
| | - Weon-Young Lee
- Department of Preventive Medicine, Chung-Ang University College of Medicine, Seoul, Korea
| | - Yong Min Ahn
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Korea
- Department of Neuropsychiatry, Seoul National University Hospital, Seoul, Korea
- Institute of Human Behavioral Medicine, Seoul National University Medical Research Center, Seoul, Korea.
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2
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Chan JKN, Wong CSM, Fang CZ, Hung SC, Lo HKY, Chang WC. Mortality risk and mood stabilizers in bipolar disorder: a propensity-score-weighted population-based cohort study in 2002-2018. Epidemiol Psychiatr Sci 2024; 33:e31. [PMID: 38779809 PMCID: PMC11362685 DOI: 10.1017/s2045796024000337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 03/26/2024] [Accepted: 04/30/2024] [Indexed: 05/25/2024] Open
Abstract
AIMS Accumulating studies have assessed mortality risk associated with mood-stabilizers, the mainstay treatment for bipolar disorder (BD). However, existing data were mostly restricted to suicide risk, focused on lithium and valproate and rarely adequately adjusted for potential confounders. This study aimed to assess comparative mortality risk with all, natural and unnatural causes between lithium, valproate and three frequently prescribed second-generation antipsychotics (SGA), with adjustment for important confounders. METHODS This population-based cohort study identified 8137 patients with first-diagnosed BD, who had exposed to lithium (n = 1028), valproate (n = 3580), olanzapine (n = 797), quetiapine (n = 1975) or risperidone (n = 757) between 2002 and 2018. Data were retrieved from territory-wide medical-record database of public healthcare services in Hong Kong. Propensity-score (PS)-weighting method was applied to optimize control for potential confounders including pre-existing chronic physical diseases, substance/alcohol use disorders and other psychotropic medications. PS-weighted Cox proportional-hazards regression was conducted to assess risk of all-, natural- and unnatural-cause mortality related to each mood-stabilizer, compared to lithium. Three sets of sensitivity analyses were conducted by restricting to patients with (i) length of cumulative exposure to specified mood-stabilizer ≥90 days and its medication possession ratio (MPR) ≥90%, (ii) MPR of specified mood-stabilizer ≥80% and MPR of other studied mood-stabilizers <20% and (iii) monotherapy. RESULTS Incidence rates of all-cause mortality per 1000 person-years were 5.9 (95% confidence interval [CI]: 4.5-7.6), 8.4 (7.4-9.5), 11.1 (8.3-14.9), 7.4 (6.0-9.2) and 12.0 (9.3-15.6) for lithium-, valproate-, olanzapine-, quetiapine- and risperidone-treated groups, respectively. BD patients treated with olanzapine (PS-weighted hazard ratio = 2.07 [95% CI: 1.33-3.22]) and risperidone (1.66 [1.08-2.55]) had significantly higher all-cause mortality rate than lithium-treated group. Olanzapine was associated with increased risk of natural-cause mortality (3.04 [1.54-6.00]) and risperidone was related to elevated risk of unnatural-cause mortality (3.33 [1.62-6.86]), relative to lithium. The association between olanzapine and increased natural-cause mortality rate was consistently affirmed in sensitivity analyses. Relationship between risperidone and elevated unnatural-cause mortality became non-significant in sensitivity analyses restricted to low MPR in other mood-stabilizers and monotherapy. Valproate- and lithium-treated groups did not show significant differences in all-, natural- or unnatural-cause mortality risk. CONCLUSION Our data showed that olanzapine and risperidone were associated with higher mortality risk than lithium, and further supported the clinical guidelines recommending lithium as the first-line mood-stabilizer for BD. Future research is required to further clarify comparative mortality risk associated with individual SGA agents to facilitate risk-benefit evaluation of alternative mood-stabilizers to minimize avoidable premature mortality in BD.
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Affiliation(s)
- Joe Kwun Nam Chan
- Department of Psychiatry, School of Clinical medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Corine Sau Man Wong
- School of Public Health, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Catherine Zhiqian Fang
- Department of Psychiatry, School of Clinical medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Samson Chun Hung
- Department of Psychiatry, School of Clinical medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Heidi Ka Ying Lo
- Department of Psychiatry, School of Clinical medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Wing Chung Chang
- Department of Psychiatry, School of Clinical medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong
- State Key Laboratory of Brain and Cognitive Science, The University of Hong Kong, Hong Kong
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3
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Ng VWS, Leung MTY, Chan EW, Lee EHM, Hayes JF, Osborn DPJ, Wing YK, Lau WCY, Man KKC, Wong ICK. Association between the mood stabilizing treatment of bipolar disorder and risk of suicide attempts: A self-controlled case series study. Psychiatry Res 2023; 325:115236. [PMID: 37172400 DOI: 10.1016/j.psychres.2023.115236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 04/21/2023] [Accepted: 05/03/2023] [Indexed: 05/15/2023]
Abstract
Bipolar disorder (BPD) is associated with high rates of suicide attempts but the anti-suicidal effect of mood stabilizing agents remains unclear. This study aimed to examine the association between mood stabilizing agents (lithium, valproate, lamotrigine, carbamazepine or antipsychotics) and risk of suicide attempts in patients with BPD using self-controlled case series study design. Among 14,087 patients with BPD who received mood stabilizing agents from 2001 to 2020 in Hong Kong, 1316 patients had at least one suicide attempts during the observation period. An increased risk of suicide attempts was observed 14 days before treatment initiation compared to non-exposed period. Following treatment initiation, an increased risk with smaller magnitude was found with the use of mood stabilizing agents. A lower risk was observed with lithium and antiepileptics while the risk remained attenuated with decreasing magnitude with antipsychotics. During 30-day post-treatment period, the risk was elevated. Therefore, this study suggests that use of mood stabilizing agents is not causally associated with an increased risk of suicide attempts. Indeed, there are potential protective effects of lithium and antiepileptics against suicide attempts. Assiduous monitoring of symptoms relapse and warning signs of suicide should be part of the management plan and discussed between clinicians, caregivers and patients.
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Affiliation(s)
- Vanessa W S Ng
- Department of Pharmacology and Pharmacy, Centre for Safe Medication Practice and Research, The University of Hong Kong, Hong Kong, China
| | - Miriam T Y Leung
- Department of Pharmacology and Pharmacy, Centre for Safe Medication Practice and Research, The University of Hong Kong, Hong Kong, China; Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Australia
| | - Esther W Chan
- Department of Pharmacology and Pharmacy, Centre for Safe Medication Practice and Research, The University of Hong Kong, Hong Kong, China; Laboratory of Data Discovery for Health (D(2)4H), Hong Kong Science Park, Hong Kong, China; Department of Pharmacy, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China; The University of Hong Kong Shenzhen Institute of Research and Innovation, Shenzhen, China
| | - Edwin H M Lee
- Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Joseph F Hayes
- Division of Psychiatry, Faculty of Brain Sciences, University College London, London, United Kingdom
| | - David P J Osborn
- Division of Psychiatry, Faculty of Brain Sciences, University College London, London, United Kingdom; Camden and Islington NHS Foundation Trust, London NW10PE, United Kingdom
| | - Yun Kwok Wing
- Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Wallis C Y Lau
- Department of Pharmacology and Pharmacy, Centre for Safe Medication Practice and Research, The University of Hong Kong, Hong Kong, China; Research Department of Practice and Policy, School of Pharmacy, University College London, London, United Kingdom; Laboratory of Data Discovery for Health (D(2)4H), Hong Kong Science Park, Hong Kong, China; Centre for Medicines Optimisation Research and Education, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Kenneth K C Man
- Department of Pharmacology and Pharmacy, Centre for Safe Medication Practice and Research, The University of Hong Kong, Hong Kong, China; Research Department of Practice and Policy, School of Pharmacy, University College London, London, United Kingdom; Laboratory of Data Discovery for Health (D(2)4H), Hong Kong Science Park, Hong Kong, China.
| | - Ian C K Wong
- Department of Pharmacology and Pharmacy, Centre for Safe Medication Practice and Research, The University of Hong Kong, Hong Kong, China; Research Department of Practice and Policy, School of Pharmacy, University College London, London, United Kingdom; Laboratory of Data Discovery for Health (D(2)4H), Hong Kong Science Park, Hong Kong, China; Aston Pharmacy School, Aston University, Birmingham, United Kingdom.
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4
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Wilkinson ST, Trujillo Diaz D, Rupp ZW, Kidambi A, Ramirez KL, Flores JM, Avila-Quintero VJ, Rhee TG, Olfson M, Bloch MH. Pharmacological and Somatic Treatment Effects on Suicide in Adults: A Systematic Review and Meta-Analysis. FOCUS (AMERICAN PSYCHIATRIC PUBLISHING) 2023; 21:197-208. [PMID: 37201149 PMCID: PMC10172559 DOI: 10.1176/appi.focus.23021006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
Background Suicide is a public health crisis. We conducted a systematic review and meta-analysis of the effects of psychopharmacologic and somatic therapies on suicide risk. Methods A systematic search of MEDLINE for studies evaluating the effects of pharmacologic (excluding antidepressants) or somatic interventions on suicide risk was conducted. Studies were included if they used a comparison group, reported on suicide death, assessed a psychopharmacological or somatic intervention, and included adults. Study quality was assessed using the Newcastle-Ottawa scale. Fifty-seven studies were included from 2940 reviewed citations. Results In bipolar disorder, lithium was associated with a reduction in the odds of suicide compared to active controls (odds ratio [OR] = .58, p = .005; k = 12) and compared to placebo/no lithium (OR = .46, p = .009; k = 9). In mixed diagnostic samples, lithium was associated with a reduction in the odds of suicide compared to placebo/no lithium (OR = .27, p < .001; k = 12), but not compared to active controls (OR = .89, p = .468; k = 7). In psychotic disorders, clozapine was associated with a reduction in the odds of suicide (OR = .46, p = .007; k = 7). Associations between suicide death and electroconvulsive therapy (OR = .77, p = .053; k = 11), non-clozapine antipsychotics in bipolar disorder (OR = .73, p = .090; k = 6) and antipsychotics in psychotic disorders (OR = .39, p = .069; k = 6) were not significant. There was no consistent relationship between antiepileptic mood stabilizers and suicide. There were insufficient studies to meta-analyze associations of suicide risk with vagus nerve stimulation, transcranial magnetic stimulation, magnetic seizure therapy, or transcranial direct current stimulation. Conclusion Lithium and clozapine have consistent data supporting protective effects against suicide in certain clinical contexts.Reprinted from Depress Anxiety 2022; 39:100-112, with permission from John Wiley and Sons. Copyright © 2022.
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Affiliation(s)
- Samuel T Wilkinson
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA (Wilkinson, Ramirez, Flores, Rhee, Bloch); Interventional Psychiatric Service, Yale School of Medicine, New Haven, Connecticut, USA (Wilkinson, Bloch); Yale Child Study Center, Yale School of Medicine, New Haven, Connecticut, USA (Diaz, Kidambi, Ramirez, Avila-Quintero, Bloch); Family and Community Medicine, University of Kentucky College of Medicine, Hazard, Kentucky, USA (Rupp); Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, New York, USA (Olfson)
| | - Daniel Trujillo Diaz
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA (Wilkinson, Ramirez, Flores, Rhee, Bloch); Interventional Psychiatric Service, Yale School of Medicine, New Haven, Connecticut, USA (Wilkinson, Bloch); Yale Child Study Center, Yale School of Medicine, New Haven, Connecticut, USA (Diaz, Kidambi, Ramirez, Avila-Quintero, Bloch); Family and Community Medicine, University of Kentucky College of Medicine, Hazard, Kentucky, USA (Rupp); Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, New York, USA (Olfson)
| | - Zachary W Rupp
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA (Wilkinson, Ramirez, Flores, Rhee, Bloch); Interventional Psychiatric Service, Yale School of Medicine, New Haven, Connecticut, USA (Wilkinson, Bloch); Yale Child Study Center, Yale School of Medicine, New Haven, Connecticut, USA (Diaz, Kidambi, Ramirez, Avila-Quintero, Bloch); Family and Community Medicine, University of Kentucky College of Medicine, Hazard, Kentucky, USA (Rupp); Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, New York, USA (Olfson)
| | - Anubhav Kidambi
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA (Wilkinson, Ramirez, Flores, Rhee, Bloch); Interventional Psychiatric Service, Yale School of Medicine, New Haven, Connecticut, USA (Wilkinson, Bloch); Yale Child Study Center, Yale School of Medicine, New Haven, Connecticut, USA (Diaz, Kidambi, Ramirez, Avila-Quintero, Bloch); Family and Community Medicine, University of Kentucky College of Medicine, Hazard, Kentucky, USA (Rupp); Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, New York, USA (Olfson)
| | - Karina L Ramirez
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA (Wilkinson, Ramirez, Flores, Rhee, Bloch); Interventional Psychiatric Service, Yale School of Medicine, New Haven, Connecticut, USA (Wilkinson, Bloch); Yale Child Study Center, Yale School of Medicine, New Haven, Connecticut, USA (Diaz, Kidambi, Ramirez, Avila-Quintero, Bloch); Family and Community Medicine, University of Kentucky College of Medicine, Hazard, Kentucky, USA (Rupp); Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, New York, USA (Olfson)
| | - José M Flores
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA (Wilkinson, Ramirez, Flores, Rhee, Bloch); Interventional Psychiatric Service, Yale School of Medicine, New Haven, Connecticut, USA (Wilkinson, Bloch); Yale Child Study Center, Yale School of Medicine, New Haven, Connecticut, USA (Diaz, Kidambi, Ramirez, Avila-Quintero, Bloch); Family and Community Medicine, University of Kentucky College of Medicine, Hazard, Kentucky, USA (Rupp); Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, New York, USA (Olfson)
| | - Victor J Avila-Quintero
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA (Wilkinson, Ramirez, Flores, Rhee, Bloch); Interventional Psychiatric Service, Yale School of Medicine, New Haven, Connecticut, USA (Wilkinson, Bloch); Yale Child Study Center, Yale School of Medicine, New Haven, Connecticut, USA (Diaz, Kidambi, Ramirez, Avila-Quintero, Bloch); Family and Community Medicine, University of Kentucky College of Medicine, Hazard, Kentucky, USA (Rupp); Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, New York, USA (Olfson)
| | - T Greg Rhee
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA (Wilkinson, Ramirez, Flores, Rhee, Bloch); Interventional Psychiatric Service, Yale School of Medicine, New Haven, Connecticut, USA (Wilkinson, Bloch); Yale Child Study Center, Yale School of Medicine, New Haven, Connecticut, USA (Diaz, Kidambi, Ramirez, Avila-Quintero, Bloch); Family and Community Medicine, University of Kentucky College of Medicine, Hazard, Kentucky, USA (Rupp); Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, New York, USA (Olfson)
| | - Mark Olfson
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA (Wilkinson, Ramirez, Flores, Rhee, Bloch); Interventional Psychiatric Service, Yale School of Medicine, New Haven, Connecticut, USA (Wilkinson, Bloch); Yale Child Study Center, Yale School of Medicine, New Haven, Connecticut, USA (Diaz, Kidambi, Ramirez, Avila-Quintero, Bloch); Family and Community Medicine, University of Kentucky College of Medicine, Hazard, Kentucky, USA (Rupp); Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, New York, USA (Olfson)
| | - Michael H Bloch
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA (Wilkinson, Ramirez, Flores, Rhee, Bloch); Interventional Psychiatric Service, Yale School of Medicine, New Haven, Connecticut, USA (Wilkinson, Bloch); Yale Child Study Center, Yale School of Medicine, New Haven, Connecticut, USA (Diaz, Kidambi, Ramirez, Avila-Quintero, Bloch); Family and Community Medicine, University of Kentucky College of Medicine, Hazard, Kentucky, USA (Rupp); Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, New York, USA (Olfson)
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Chen PH, Tsai SY, Chen PY, Pan CH, Su SS, Chen CC, Kuo CJ. Mood stabilizers and risk of all-cause, natural, and suicide mortality in bipolar disorder: A nationwide cohort study. Acta Psychiatr Scand 2023; 147:234-247. [PMID: 36367926 DOI: 10.1111/acps.13519] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 11/01/2022] [Accepted: 11/04/2022] [Indexed: 11/13/2022]
Abstract
OBJECTIVES People with bipolar disorder have an elevated risk of mortality. This study evaluated associations between the use of mood stabilizers and the risks of all-cause mortality, suicide, and natural mortality in a national cohort of people with bipolar disorder. METHODS In this nationwide cohort study, we used data from January 1, 2000, to December 31, 2016, collected from Taiwan's National Health Insurance Research Database and included 25,787 patients with bipolar disorder. Of these patients, 4000 died during the study period (including 760 and 2947 from suicide and natural causes, respectively). Each standardized mortality ratio (SMR) was calculated as the ratio of observed mortality in the bipolar cohort to the number of expected deaths in the general population. Multivariable Cox proportional hazards regression with a time-dependent model was performed to estimate the hazard ratio (HR) of each mood stabilizer with each mortality outcome. RESULTS The SMRs of all-cause mortality, suicide, and natural mortality in the bipolar disorder cohort were 5.26, 26.02, and 4.68, respectively. The use of mood stabilizers was significantly associated with decreased risks of all-cause mortality (adjusted HR [aHR] = 0.58, p< 0.001), suicide (aHR = 0.60, p < 0.001), and natural mortality (aHR = 0.55, p < 0.001) within a 5-year follow-up period after index admission. Among the individual mood stabilizers, lithium was associated with the lowest risks of all-cause mortality (aHR = 0.38, p < 0.001), suicide (aHR = 0.39, p < 0.001), and natural mortality (aHR = 0.37, p < 0.001). CONCLUSION In addition to having protective effects against suicide and all-cause mortality, mood stabilizers also exert a substantial protective effect against natural mortality, with lithium associated with the lowest risk of mortality.
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Affiliation(s)
- Pao-Huan Chen
- Department of Psychiatry, Taipei Medical University Hospital, Taipei, Taiwan.,Psychiatric Research Center, Taipei Medical University Hospital, Taipei, Taiwan.,Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Shang-Ying Tsai
- Department of Psychiatry, Taipei Medical University Hospital, Taipei, Taiwan.,Psychiatric Research Center, Taipei Medical University Hospital, Taipei, Taiwan.,Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Po-Yu Chen
- Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan
| | - Chun-Hung Pan
- Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan.,Department of Psychology, National Chengchi University, Taipei, Taiwan
| | - Sheng-Siang Su
- Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan
| | - Chiao-Chicy Chen
- Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.,Department of Psychiatry, Mackay Memorial Hospital, Taipei, Taiwan.,Department of Psychiatry, Mackay Medical College, Taipei, Taiwan
| | - Chian-Jue Kuo
- Psychiatric Research Center, Taipei Medical University Hospital, Taipei, Taiwan.,Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.,Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan
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6
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Lin CC, Yeh LL, Pan YJ. Degree of exposure to psychotropic medications and mortality in people with bipolar disorder. Acta Psychiatr Scand 2023; 147:186-197. [PMID: 36217288 DOI: 10.1111/acps.13509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 09/28/2022] [Accepted: 10/06/2022] [Indexed: 01/24/2023]
Abstract
OBJECTIVES To investigate the associations between psychotropic medication dosage and mortality in patients with bipolar disorder. METHODS A nationwide cohort of individuals aged ≥15 years who had received a diagnosis of bipolar disorder in 2010 was identified from the Taiwanese national health-care database linked with the mortality registry and followed up for 5 years. The mean defined daily dose (DDD) of mood stabilizers, antipsychotics, antidepressants, and sedative-hypnotics was estimated, and survival analyses were conducted to assess the effects of degree of exposure to psychotropic medications on mortality. RESULTS A total of 49,298 individuals (29,048 female individuals, 58.92%) with bipolar disorder were included. Compared with individuals without exposure to mood stabilizers, those prescribed mood stabilizers had a decreased overall mortality risk, regardless of exposure dosage. By contrast, compared with a reference group with no exposure to antipsychotics, individuals using antipsychotics had dose-dependent, increased mortality in both overall causes of deaths and deaths due to cardiovascular diseases, with hazard ratios of 1.13 (95% CI: 1.21-1.42) in the low-dose (<0.5 DDD) group, 1.69 (1.51-1.90) in the moderate-dose (0.5-1.5 DDD) group, and 2.08 (1.69-2.57) in the high-dose (>1.5 DDD) group for overall mortality. CONCLUSIONS In sum, mood stabilizers were associated with decreased overall mortality in individuals with bipolar disorder, regardless of the dosage. However, the use of antipsychotics appeared to be associated with a dose-dependent increased mortality risk. Owing to study limitations, precise information on prior use of psychotropic medications, and patient's adherence to medication are not available. Potential adverse effects and benefits should be carefully considered when prescribing psychotropic medications for long-term use in patients with bipolar disorder.
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Affiliation(s)
- Chu-Chun Lin
- Department of Psychiatry, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Ling-Ling Yeh
- Graduate School of Humanities and Social Sciences, Dharma Drum Institute of Liberal Arts, New Taipei City, Taiwan
| | - Yi-Ju Pan
- Department of Psychiatry, Far Eastern Memorial Hospital, New Taipei City, Taiwan.,Institute of Public Health, National Yang Ming Chiao Tung University School of Medicine, Taipei, Taiwan
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7
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Wilkinson ST, Trujillo Diaz D, Rupp ZW, Kidambi A, Ramirez KL, Flores JM, Avila-Quintero VJ, Rhee TG, Olfson M, Bloch MH. Pharmacological and somatic treatment effects on suicide in adults: A systematic review and meta-analysis. Depress Anxiety 2022; 39:100-112. [PMID: 34762330 DOI: 10.1002/da.23222] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 10/05/2021] [Accepted: 10/26/2021] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Suicide is a public health crisis. We conducted a systematic review and meta-analysis of the effects of psychopharmacologic and somatic therapies on suicide risk. METHODS A systematic search of MEDLINE for studies evaluating the effects of pharmacologic (excluding antidepressants) or somatic interventions on suicide risk was conducted. Studies were included if they used a comparison group, reported on suicide death, assessed a psychopharmacological or somatic intervention, and included adults. Study quality was assessed using the Newcastle-Ottawa scale. Fifty-seven studies were included from 2940 reviewed citations. RESULTS In bipolar disorder, lithium was associated with a reduction in the odds of suicide compared to active controls (odds ratio [OR] = .58, p = .005; k = 12) and compared to placebo/no lithium (OR = .46, p = .009; k = 9). In mixed diagnostic samples, lithium was associated with a reduction in the odds of suicide compared to placebo/no lithium (OR = .27, p < .001; k = 12), but not compared to active controls (OR = .89, p = .468; k = 7). In psychotic disorders, clozapine was associated with a reduction in the odds of suicide (OR = .46, p = .007; k = 7). Associations between suicide death and electroconvulsive therapy (OR = .77, p = .053; k = 11), non-clozapine antipsychotics in bipolar disorder (OR = .73, p = .090; k = 6) and antipsychotics in psychotic disorders (OR = .39, p = .069; k = 6) were not significant. There was no consistent relationship between antiepileptic mood stabilizers and suicide. There were insufficient studies to meta-analyze associations of suicide risk with vagus nerve stimulation, transcranial magnetic stimulation, magnetic seizure therapy, or transcranial direct current stimulation. CONCLUSION Lithium and clozapine have consistent data supporting protective effects against suicide in certain clinical contexts.
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Affiliation(s)
- Samuel T Wilkinson
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA.,Interventional Psychiatric Service, Yale School of Medicine, New Haven, Connecticut, USA
| | | | - Zachary W Rupp
- Family and Community Medicine, University of Kentucky College of Medicine, Hazard, Kentucky, USA
| | - Anubhav Kidambi
- Yale Child Study Center, Yale School of Medicine, New Haven, Connecticut, USA
| | - Karina L Ramirez
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA.,Yale Child Study Center, Yale School of Medicine, New Haven, Connecticut, USA
| | - José M Flores
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA
| | | | - T Greg Rhee
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA
| | - Mark Olfson
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, New York, USA
| | - Michael H Bloch
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA.,Interventional Psychiatric Service, Yale School of Medicine, New Haven, Connecticut, USA.,Yale Child Study Center, Yale School of Medicine, New Haven, Connecticut, USA
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8
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Hawkins EM, Coryell W, Leung S, Parikh SV, Weston C, Nestadt P, Nurnberger JI, Kaplin A, Kumar A, Farooqui AA, El-Mallakh RS. Effects of somatic treatments on suicidal ideation and completed suicides. Brain Behav 2021; 11:e2381. [PMID: 34661999 PMCID: PMC8613439 DOI: 10.1002/brb3.2381] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 08/14/2021] [Accepted: 09/14/2021] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVE This work was undertaken to define and characterize the role of currently available somatic treatments in psychiatry in either increasing or reducing the risk for suicide. METHODS Members of the Suicide Prevention Task Group of the National Network of Depression Centers performed a literature review of somatic treatments known to increase or reduce the risk for suicide. The reviews ventured to include all relevant information about the risk for both suicide ideation and completed suicides. RESULTS Lithium and clozapine are the only two somatic treatments that have high-quality data documenting their antisuicide effects in mood disorders and schizophrenia, respectively. Lithium discontinuation is also associated with increased suicide risk. Ketamine and esketamine may have a small, but immediate, antisuicide effect. Despite the recent Food and Drug Administration approval of esketamine use in depressed suicidal patients, the small disproportional overrepresentation of suicide in subjects who had received esketamine versus placebo (3 vs. 0 among > 3500 subjects) requires ongoing evaluation. The purported antisuicide effect of electroconvulsive therapy is based on low-quality data. The effect of antidepressants is not at all clear. There appears to be direct evidence for antidepressants increasing suicidal ideation and the risk for suicide over the short-term in young people, but indirect (low quality) evidence that antidepressants reduce suicide risk over the long term. CONCLUSIONS Clinicians have an expanding pharmacopeia to address suicide potential in their patients. Some of the agents with documented antisuicide effects may also increase suicidality under specific circumstances.
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Affiliation(s)
- Elise M Hawkins
- Department of Psychiatry and Behavioral Sciences, University of Louisville, Louisville, Kentucky, USA
| | - William Coryell
- Roy J. and Lucille A. Carver College of Medicine, The University of Iowa, Iowa City, Iowa, USA
| | - Stephen Leung
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA
| | - Sagar V Parikh
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA
| | - Cody Weston
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Paul Nestadt
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - John I Nurnberger
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Adam Kaplin
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Anupama Kumar
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Ali A Farooqui
- Department of Psychiatry and Behavioral Sciences, University of Louisville, Louisville, Kentucky, USA
| | - Rif S El-Mallakh
- Department of Psychiatry and Behavioral Sciences, University of Louisville, Louisville, Kentucky, USA
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- Department of Psychiatry and Behavioral Sciences, University of Louisville, Louisville, Kentucky, USA
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9
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Abstract
Individuals diagnosed with schizophrenia or bipolar disorder have a life expectancy 15-20 years shorter than that in the general population. The rate of unnatural deaths, such as suicide and accidents, is high for these patients. Despite this increased proportion of unnatural deaths, physical conditions account for approximately 70% of deaths in patients with either schizophrenia or bipolar disorder, with cardiovascular disease contributing 17.4% and 22.0% to the reduction in overall life expectancy in men and women, respectively. Risk factors for cardiovascular disease, such as smoking, unhealthy diet and lack of exercise, are common in these patients, and lifestyle interventions have been shown to have small effects. Pharmacological interventions to reduce risk factors for cardiovascular disease have been proven to be effective. Treatment with antipsychotic drugs is associated with reduced mortality but also with an increased risk of weight gain, dyslipidaemia and diabetes mellitus. These patients have higher risks of both myocardial infarction and stroke but a lower risk of undergoing interventional procedures compared with the general population. Data indicate a negative attitude from clinicians working outside the mental health fields towards patients with severe mental illness. Education might be a possible method to decrease the negative attitudes towards these patients, thereby improving their rates of diagnosis and treatment.
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10
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Rhee TG, Olfson M, Nierenberg AA, Wilkinson ST. 20-Year Trends in the Pharmacologic Treatment of Bipolar Disorder by Psychiatrists in Outpatient Care Settings. Am J Psychiatry 2020; 177:706-715. [PMID: 32312111 PMCID: PMC7577523 DOI: 10.1176/appi.ajp.2020.19091000] [Citation(s) in RCA: 130] [Impact Index Per Article: 32.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
OBJECTIVE Pharmacological options for treating bipolar disorder have increased over the past 20 years, with several second-generation antipsychotics receiving regulatory approval in the 1990s. The authors describe trends in use of pharmacological agents in the outpatient management of bipolar disorder. METHODS Using nationally representative data from the 1997-2016 National Ambulatory Medical Care Surveys, the authors examined trends in the use of mood stabilizers, first- and second-generation antipsychotics, and antidepressants among psychiatrist visits for which bipolar disorder was listed among the primary diagnoses. A logistic regression model was used to identify statistically significant trends, with covariates including age, gender, race/ethnicity, and primary insurance. RESULTS Antipsychotics were increasingly more commonly prescribed, increasing from 12.4% of outpatient visits for bipolar disorder in the 1997-2000 period to 51.4% in the 2013-2016 period (adjusted odds ratio=5.05, 95% CI=3.65-7.01). Use of mood stabilizers decreased from 62.3% of visits for bipolar disorder in the 1997-2000 period to 26.4% in the 2013-2016 period (adjusted odds ratio=0.18, 95% CI=0.13-0.27). Prescription of antidepressants occurred in 47.0% of visits for bipolar disorder in the 1997-2000 period and 57.5% in the 2013-2016 period. Prescription of an antidepressant without a mood stabilizer increased substantially, from 17.9% in the 1997-2000 period to 40.9% in the 2013-2016 period (adjusted odds ratio=2.88, 95% CI=2.06-4.03). CONCLUSIONS Substantial changes have occurred in the treatment of bipolar disorder over the past 20 years, with second-generation antipsychotics in large measure supplanting traditional mood stabilizers. Antidepressant prescriptions persisted despite a lack of evidence for their efficacy in bipolar disorder and concerns about increasing the risk of mania. Research is needed to compare the real-world effectiveness and tolerability of newer antipsychotics with those of traditional mood stabilizers.
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Affiliation(s)
- Taeho Greg Rhee
- Department of Public Health Sciences, School of Medicine, University of Connecticut, Farmington, CT,Department of Psychiatry, School of Medicine, Yale University, New Haven, CT
| | - Mark Olfson
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, NY
| | - Andrew A. Nierenberg
- Center of Bipolar Treatment Innovation, Massachusetts General Hospital, Boston, MA,Department of Psychiatry, Harvard Medical School, Harvard University, Boston, MA
| | - Samuel T. Wilkinson
- Department of Psychiatry, School of Medicine, Yale University, New Haven, CT
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11
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Chen TY, Kamali M, Chu CS, Yeh CB, Huang SY, Mao WC, Lin PY, Chen YW, Tseng PT, Hsu CY. Divalproex and its effect on suicide risk in bipolar disorder: A systematic review and meta-analysis of multinational observational studies. J Affect Disord 2019; 245:812-818. [PMID: 30699864 DOI: 10.1016/j.jad.2018.11.093] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Revised: 11/10/2018] [Accepted: 11/12/2018] [Indexed: 12/17/2022]
Abstract
BACKGROUND Divalproex has become the most prevalent mood stabilizer for bipolar disorder. However, little is known its effects in the prevention of suicide in patients with bipolar disorder, and recent FDA announcement indicated an increased risk of suicidality when using anti-epileptic agents such as divalproex. The aim of this study is to investigate the effect of divalproex on suicide risk in patients with bipolar disorder. METHODS A search strategy was used for the PubMed, Embase, ProQuest, ScienceDirect, Cochrane Library, ClinicalKey, Web of Science, and ClinicalTrials.gov until June 13th, 2018. Peer-reviewed observationally clinical studies in humans, investigating the association of divalproex and suicidality in patients with bipolar disorder were included. A random-effects meta-analysis was implemented to calculate the relative risk (RR) and 95% confidence intervals (CIs) for suicidality among patients receiving divalproex and those without. RESULTS Total 6 studies were included in the final meta-analysis. There was no significant difference in the incidence rates (reported as [RR]; 95% CI) of suicide attempts (0.921; 0.383-2.215) or completed suicides (0.607; 0.180-2.043) between participants receiving divalproex vs. no medication. There was no significant difference in the incidence rates of suicide attempts (0.815; 0.453-1.466) or completed suicides (1.009; 0.410-2.484) between participants receiving divalproex and carbamazepine. LIMITATIONS The significantly heterogeneous sample sources and study design amount the included trials. CONCLUSIONS Treatment with divalproex did not reduce or increase the incidence of suicide-related events in patients with bipolar disorder.
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Affiliation(s)
- Tien-Yu Chen
- Department of Psychiatry, Tri-Service General Hospital; School of Medicine, National Defense Medical Center, Taipei, Taiwan; Institute of Brain Science, National Yang-Ming University, Taipei, Taiwan
| | - Masoud Kamali
- Department of Psychiatry, Massachusetts General Hospital; Harvard Medical School, Boston, United States
| | - Che-Sheng Chu
- Department of Psychiatry and Center for Geriatric and Gerontology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Chin-Bin Yeh
- Department of Psychiatry, Tri-Service General Hospital; School of Medicine, National Defense Medical Center, Taipei, Taiwan
| | - San-Yuan Huang
- Department of Psychiatry, Tri-Service General Hospital; School of Medicine, National Defense Medical Center, Taipei, Taiwan
| | - Wei-Chung Mao
- Institute of Brain Science, National Yang-Ming University, Taipei, Taiwan; Department of Psychiatry, Cheng Hsin General Hospital, Taipei, Taiwan
| | - Pao-Yen Lin
- Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan; Center for Translational Research in Biomedical Sciences, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Yen-Wen Chen
- Prospect Clinic for Otorhinolaryngology and Neurology, Kaohsiung, Taiwan
| | - Ping-Tao Tseng
- WinShine Clinics in Specialty of Psychiatry, Number 68, Nantai Road, Xinxing District, Kaohsiung 800, Taiwan.
| | - Chung-Yao Hsu
- Faculty of Medicine, Department of Neurology, Kaohsiung Medical University Hospital, College of Medicine, Kaohsiung Medical University, No.100, Tzyou 1st Road, Kaohsiung 80754, Taiwan.
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12
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Raju Sagiraju HK, Wang CP, Amuan ME, Van Cott AC, Altalib HH, Pugh MJV. Antiepileptic drugs and suicide-related behavior: Is it the drug or comorbidity? Neurol Clin Pract 2018; 8:331-339. [PMID: 30140585 DOI: 10.1212/cpj.0000000000000489] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Accepted: 04/11/2018] [Indexed: 11/15/2022]
Abstract
Background We sought to compare trends of suicide-related behavior (SRB) before and after initiation of antiepileptic drug (AED) therapy among AED users (with and without epilepsy) to that of individuals without AED use controlling for sociodemographic characteristics and mental health comorbidity. Methods We used national Veterans Health Administration (VHA) data for post-9/11 veterans who received VHA care (2013-2014) without prior AED use. We conducted generalized estimation equation (GEE) analyses, stratified by epilepsy status and type of AED received, to assess the trend of SRB prevalence the year prior to and after the index date (date of first AED prescription/date of first health care encounter for non-AED users) controlling for sociodemographic factors and mental health comorbidity. Results The GEE analysis showed significant curvilinear trends of SRB prevalence over the 24-month study period among the AED users, indicating that the probability of SRB diagnoses increased over time with a peak before the index month and decreased thereafter. Similar patterns were observed among non-AED users, but significantly lower odds for SRB. Among AED users, there were no significant differences by epilepsy status; however, higher SRB prevalence and differential SRB trajectory measures were observed among those who received AEDs with mood-stabilizing action. Conclusions The peak of SRB prior to and rapid reduction in SRB after initiation of AED, and the finding that individuals eventually prescribed a mood-stabilizing AED (vs other AED or levetiracetam) had higher odds of SRB, suggests a strong possibility that the relationship of AED and SRB is one of residual confounding.
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Affiliation(s)
- Hari K Raju Sagiraju
- South Texas Veterans Health Care System (HKRS, C-PW), San Antonio; Division of General and Hospital Medicine (HKRS) and Department of Epidemiology & Biostatistics (C-PW), University of Texas Health Science Center at San Antonio; Center for Healthcare Organization and Implementation Research (MEA), Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA; VA Pittsburgh Health Care System (ACVC); Department of Neurology (ACVC), University of Pittsburgh, PA; VA Connecticut Health Care System (HHA), West Haven; Department of Neurology & Psychiatry (HHA), Yale School of Medicine, New Haven, CT; Informatics, Decision-Enhancement and Analytic Sciences Center (IDEAS 2.0) (MJVP), VA Salt Lake City Health Care System; and Division of Epidemiology (MJVP), University of Utah Health Science Center
| | - Chen-Pin Wang
- South Texas Veterans Health Care System (HKRS, C-PW), San Antonio; Division of General and Hospital Medicine (HKRS) and Department of Epidemiology & Biostatistics (C-PW), University of Texas Health Science Center at San Antonio; Center for Healthcare Organization and Implementation Research (MEA), Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA; VA Pittsburgh Health Care System (ACVC); Department of Neurology (ACVC), University of Pittsburgh, PA; VA Connecticut Health Care System (HHA), West Haven; Department of Neurology & Psychiatry (HHA), Yale School of Medicine, New Haven, CT; Informatics, Decision-Enhancement and Analytic Sciences Center (IDEAS 2.0) (MJVP), VA Salt Lake City Health Care System; and Division of Epidemiology (MJVP), University of Utah Health Science Center
| | - Megan E Amuan
- South Texas Veterans Health Care System (HKRS, C-PW), San Antonio; Division of General and Hospital Medicine (HKRS) and Department of Epidemiology & Biostatistics (C-PW), University of Texas Health Science Center at San Antonio; Center for Healthcare Organization and Implementation Research (MEA), Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA; VA Pittsburgh Health Care System (ACVC); Department of Neurology (ACVC), University of Pittsburgh, PA; VA Connecticut Health Care System (HHA), West Haven; Department of Neurology & Psychiatry (HHA), Yale School of Medicine, New Haven, CT; Informatics, Decision-Enhancement and Analytic Sciences Center (IDEAS 2.0) (MJVP), VA Salt Lake City Health Care System; and Division of Epidemiology (MJVP), University of Utah Health Science Center
| | - Anne C Van Cott
- South Texas Veterans Health Care System (HKRS, C-PW), San Antonio; Division of General and Hospital Medicine (HKRS) and Department of Epidemiology & Biostatistics (C-PW), University of Texas Health Science Center at San Antonio; Center for Healthcare Organization and Implementation Research (MEA), Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA; VA Pittsburgh Health Care System (ACVC); Department of Neurology (ACVC), University of Pittsburgh, PA; VA Connecticut Health Care System (HHA), West Haven; Department of Neurology & Psychiatry (HHA), Yale School of Medicine, New Haven, CT; Informatics, Decision-Enhancement and Analytic Sciences Center (IDEAS 2.0) (MJVP), VA Salt Lake City Health Care System; and Division of Epidemiology (MJVP), University of Utah Health Science Center
| | - Hamada H Altalib
- South Texas Veterans Health Care System (HKRS, C-PW), San Antonio; Division of General and Hospital Medicine (HKRS) and Department of Epidemiology & Biostatistics (C-PW), University of Texas Health Science Center at San Antonio; Center for Healthcare Organization and Implementation Research (MEA), Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA; VA Pittsburgh Health Care System (ACVC); Department of Neurology (ACVC), University of Pittsburgh, PA; VA Connecticut Health Care System (HHA), West Haven; Department of Neurology & Psychiatry (HHA), Yale School of Medicine, New Haven, CT; Informatics, Decision-Enhancement and Analytic Sciences Center (IDEAS 2.0) (MJVP), VA Salt Lake City Health Care System; and Division of Epidemiology (MJVP), University of Utah Health Science Center
| | - Mary Jo V Pugh
- South Texas Veterans Health Care System (HKRS, C-PW), San Antonio; Division of General and Hospital Medicine (HKRS) and Department of Epidemiology & Biostatistics (C-PW), University of Texas Health Science Center at San Antonio; Center for Healthcare Organization and Implementation Research (MEA), Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA; VA Pittsburgh Health Care System (ACVC); Department of Neurology (ACVC), University of Pittsburgh, PA; VA Connecticut Health Care System (HHA), West Haven; Department of Neurology & Psychiatry (HHA), Yale School of Medicine, New Haven, CT; Informatics, Decision-Enhancement and Analytic Sciences Center (IDEAS 2.0) (MJVP), VA Salt Lake City Health Care System; and Division of Epidemiology (MJVP), University of Utah Health Science Center
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13
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Caley CF, Perriello E, Golden J. Antiepileptic drugs and suicide-related outcomes in bipolar disorder: A descriptive review of published data. Ment Health Clin 2018; 8:138-147. [PMID: 29955559 PMCID: PMC6007633 DOI: 10.9740/mhc.2018.05.138] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Introduction: In January 2008 the US Food and Drug Administration issued a warning to healthcare professionals about the potential for an increased risk of suicidal thinking and behavior associated with antiepileptic drugs (AEDs). Given that AEDs are important for treating bipolar disorder (BD), a better understanding of suicide-related events is necessary. Methods: A PubMed search was performed using the following search terms: anticonvulsant OR valpro* OR carbamazepine OR lamotrigine OR oxcarbazepine OR topiramate AND bipolar AND suicid*. The objective was to identify published investigations reporting rate and/or risk data of suicide-related outcomes in BD patients treated with AED monotherapy. Results: The search identified 323 reviewable citations, with 13 of these studies (4.0%) being reviewed. Valproate was studied most often, and lithium treatment was frequently used as a reference group. Carbamazepine and lamotrigine had small treatment exposure durations. Suicide attempts and suicide deaths were studied the most; a few trials investigated suicidal thinking and/or hospitalizations for suicidal behavior. Suicide attempt rates occurred in the following order: no treatment > carbamazepine > valproate > lithium, while suicide death rates were: no treatment > valproate > lithium > carbamazepine. For valproate, the risk of suicide attempts and suicide death appeared higher than lithium, but lower than no treatment. Discussion: Investigating suicide-related events for AEDs in BD is difficult; more data are necessary for valproate, carbamazepine, and lamotrigine. An improved understanding of AED treatment and suicide-related events in BD may help pharmacists become more effective at supporting their patients with BD.
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Affiliation(s)
- Charles F Caley
- Clinical Professor and Chair, Department of Pharmacy Practice, Western New England University, College of Pharmacy and Health Sciences, Springfield, Massachusetts,
| | - Emily Perriello
- Emergency Medicine Clinical Pharmacy Specialist, Department of Pharmacy, University of North Carolina Medical Center, Chapel Hill, North Carolina
| | - Julia Golden
- Clinical Research Assistant, Burlingame Center for Psychiatric Research and Education, Institute of Living, Hartford, Connecticut
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