Citation

Smith EG, Austin KL, Kim HM, Eisen SV, Kilbourne AM, Miller DR, Zivin K, Hannemann C, Sauer BC, Valenstein M. Br. J. Psychiatry 2015; 207(1): 55-63.

Affiliation

Eric G. Smith, MD, PhD, MPH, VA Center for Healthcare Organization and Implementation Research, Department of Veterans Affairs VA Medical Center, Bedford, Massachusetts, and Departments of Psychiatry and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts; Karen L. Austin, MPH, Serious Mental Illness Treatment Resource and Evaluation Center, Department of Veterans Affairs, Ann Arbor, Michigan; Hyungjin Myra Kim, ScD, VA Center for Clinical Management Research, Department of Veterans Affairs VA Medical Center, Ann Arbor, Michigan, and Center for Statistical Consultation and Research, University of Michigan, Ann Arbor, Michigan; Susan V. Eisen, PhD, VA Center for Healthcare Organization and Implementation Research, Department of Veterans Affairs VA Medical Center, Bedford, Massachusetts, and Department of Health Policy and Management, Boston University School of Public Health, Boston, Massachusetts; Donald R. Miller, ScD, VA Center for Healthcare Organization and Implementation Research, Department of Veterans Affairs VA Medical Center, Bedford, Massachusetts; Amy M. Kilbourne, PhD, MPH, Quality Enhancement Research Initiative (QUERI), Department of Veterans Affairs, Washington DC, and Department of Psychiatry, University of Michigan Medical School, Ann Arbor, Michigan; Kara Zivin, PhD, VA Center for Clinical Management Research, Department of Veterans Affairs VA Medical Center, Ann Arbor, Michigan, and Department of Psychiatry, University of Michigan Medical School, Ann Arbor, Michigan; Claire Hannemann, MPH, Serious Mental Illness Treatment Resource and Evaluation Center, Department of Veterans Affairs, Ann Arbor, Michigan; Brian C. Sauer, PhD, VA IDEAS2.0 Center and Health Services Research and Development Researcher Enhancement Award Program, Department of Veterans Affairs, Salt Lake City, Utah, and Department of Internal Medicine, University of Utah, Salt Lake City, Utah; Marcia Valenstein, MD, MS, VA Center for Clinical Management Research, Department of Veterans Affairs VA Medical Center, Ann Arbor, Michigan, and Department of Psychiatry, University of Michigan Medical School, Ann Arbor, Michigan, USA.

Copyright

(Copyright © 2015, Royal College of Psychiatry)

DOI

10.1192/bjp.bp.113.138685

PMID

25953891

Abstract

Background The mood stabilisers lithium and valproate might plausibly have differing associations with mortality because of differing effects on mental health and various physiological indicators. Aims To assess associations between lithium, valproate and non-suicide mortality.

METHOD Intention-to-treat, propensity score-matched cohort study.

RESULTS Lithium was associated with significantly reduced non-suicide mortality in the intent-to-treat cohort over 0-90 days (hazard ratio (HR) = 0.67, 95% CI 0.51-0.87) but not longer. In secondary analyses, a sizeable reduction in mortality was observed during active treatment with lithium across all time periods studied (for example 365-day HR = 0.62, 95% CI 0.45-0.84), but significantly increased risks were observed among patients discontinuing lithium by 180 days (HR = 1.54, 95% CI 1.01-2.37).

CONCLUSIONS Patients initiating lithium had lower non-suicide mortality over 0-90 days than patients initiating valproate and consistently lower non-suicide mortality among patients maintaining treatment, but elevated risk among patients discontinuing treatment by 180 days. Although residual confounding or selection effects cannot be excluded, this study suggests potential benefits to enhancing lithium treatment persistence and the monitoring of patients discontinuing lithium. There is a need for further research.

Language: en