People with bipolar disorder have a high risk for suicide attempts and completed suicides, making the choice of treatment critical. Many people are treated for bipolar disorder with lithium or divalproex, separately or in combination. Dr. Eileen Ahearn used her AFSP Standard Research Grant to study the relationship between these treatments and suicide attempts in veterans treated for bipolar disorder 1 or 2 in five different Veterans Administration Hospitals. Her findings were published in the Journal of Affective Disorders in 2012.
Dr. Ahearn reviewed records of 1306 veterans treated for bipolar disorder over six years. The computerized pharmacy records of VA patients were used to determine exposure to medications including lithium, divalproex and antipsychotics, and emergency room, inpatient and outpatient records were reviewed to identify suicidal behavior. Over the six years there were 117 suicide attempts and two people died by suicide. Participants’ medication use was irregular with most experiencing long periods both on and off medicine. During the periods while on medicine, the most frequently prescribed medicine was divalproex and the least frequently prescribed was lithium. Fewer patients received lithium; though when they did, they stayed on it longer than either of the other two medicines. Patients were commonly prescribed more than one of these three medications at a time.
The study showed that most of the suicide attempts (59%) occurred when the veterans were not taking any medication. Among patients taking a single medicine, those taking only lithium were least likely to make a suicide attempt whereas those taking only antipsychotics were the most likely to make a suicide attempt. Patients taking lithium and divalproex together had the absolute lowest rate of attempts.
This study demonstrates that medicines for bipolar disorder can help reduce suicide attempt rates and that those who do not take medicine are at greatest risk for a suicide attempt. It also shows that mood stabilizers such as lithium and divalproex are most effective, especially when taken together, while antipsychotics without mood stabilizers are far less effective at reducing the rate of suicide attempts.
Eileen Ahearn, MD is a psychiatrist at William S. Middleton Memorial Veterans Hospital in Madison, Wisconsin.
Published article from this study:
- Ahearn EP, Chen P, Hertzberg M, Cornette M, Suvalsky L, Cooley-Olson D, Swanlund J, Eickhoff H, Becker T, Krahn D. (2013) Suicide attempts in veterans with bipolar disorder during treatment with lithium, divalproex, and atypical antipsychotics. Journal of Affective Disorders,145(1):77-82.