Newer prophylactic agents for bipolar disorder and their influence on suicidality

Lithium has been found to be efficacious in the prevention of suicide. We retrospectively evaluated data of 128 patients with BD for suicidal ideation treated with various mood-stabilizers ≥3 months.

Patients had monthly visits and ratings (IDS-C, YMRS, CGI-BP). Mean follow-up was 13.3±12.1 months (142.1 patient yrs). IDS-C-Ratings with a score of ≥2 of the „item 18– Suicidality“ were identified. Mood stabilizers treatment at the corresponding time points of ratings were retrieved from the clinician version of the life chart and patients records. For statistical analysis the chi-square test, the Fisher-Yates test and the t-test were used. Relative risk compared to lithium was calculated.

38 (29.7%) patients had IDS-C item–18 positive ratings (99 ratings). There was no significant difference in basic characteristics between Item–18 positive and –negative patients. Peak of score 3 was 132.7±194.6 days, score 2 had its peak 255.2±296.3 days after enrolment. There was no statistically significant difference for any anticonvulsant compared to lithium of having an item–18 positive score. The relative risk for having an item–18 positive score with lamotrigine was lower (RR=.85).

We found no significant differences in suicidal ideation when comparing treatment with various mood stabilizers and lithium. There was a lower relative risk of suicidal ideation for lamotrigine compared to lithium. In addition, the severity of suicidality seems to decrease in our cohort over time.