Mood Stabilizers Show Protective Effects Against Suicide

TOPLINE:

Recent lithium and valproate use was associated with a 34%-46% lower risk for suicide in patients with schizophrenia or bipolar disorder (BD), investigators leading a large cohort study reported.

METHODOLOGY:

• In a retrospective cohort study, data were analyzed from the National Health Information Database in South Korea.
• The study included more than 100,000 patients with schizophrenia and more than 96,000 patients with BD diagnosed between 2007 and 2010, with follow-up occurring until death or the end of 2017.
• Researchers assessed the association between suicide mortality and the previous month’s prescriptions of clozapine, lithium, and valproate, along with other psychotropic drugs.
• Suicide deaths were identified using Korean Classification of Diseases (KCD) codes from the National Statistics Organization database.

TAKEAWAY:

• Annual suicide rates per 100,000 person-years were 308.0 and 285.1 for schizophrenia and BD, respectively.
• After adjusting for the factors such as age, sex, and comorbidities, recent lithium use was associated with a significantly lower risk for suicide in patients with schizophrenia (hazard ratio [HR], 0.6; 95% CI, 0.5-0.7) and in those with BD (HR, 0.5; 95% CI, 0.4-0.7). Recent valproate use was also associated with a significantly lower suicide risk in patients with schizophrenia (HR, 0.6; 95% CI, 0.5-0.7) and in those with BD (HR, 0.7; 95% CI, 0.6-0.8).
• Recent clozapine use tended to be associated with a lower risk for suicide, especially in patients with schizophrenia, but the trend failed to reach statistical significance.
• On the other hand, recent use of psychotropic drugs other than antipsychotics was associated with a higher risk for suicide in those with schizophrenia or with BD (HRs, 1.4 and 1.3, respectively).

IN PRACTICE:

“Since treatment with lithium or valproate comes with various adverse effects such as weight gain, nephrotoxicity, hypothyroidism, teratogenicity, and thrombocytopenia, clinical decision making would be needed to take a balance between benefits and risk of prescribing lithium and valproate to suicidal individuals with [schizophrenia] or BD,” the investigators wrote.

SOURCE:

This study was led by Junhee Lee, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea. It was published online on March 26 in the Journal of Psychiatric Research.

LIMITATIONS:

Diagnoses were based on medical claims rather than structured clinical assessments, potentially affecting accuracy. Suicide was determined using death records only, potentially missing nonfatal attempts. The use of limited KCD codes may have led to the underreporting of suicide deaths. Additionally, adjustments for the risk for suicide relied on demographic factors alone rather than on clinical factors such as symptom severity.

DISCLOSURES:

The study was funded by Eulji University, Daejeon, South Korea. The investigators reported no relevant conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.