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Abstract
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Background
Bipolar disorder (BD) is associated with a high incidence of intentional self-harm and suicide attempts (SH/SA), however the effectiveness of mood-stabilizers on SH/SA remains controversial. We aimed to evaluate the real-world effectiveness of mood-stabilizers (lithium, lamotrigine, valproate, olanzapine, risperidone, aripiprazole, clozapine, and quetiapine) on SH/SA in patients with BD.
Methods
A two-year mirror-image design (traditional and reverse) was applied using data from nationwide Danish healthcare registers.
Results
In the traditional mirror-image design, treatment initiation with valproate was associated with a decreased SH/SA-incidence in all patients with BD (from 18 to 11 events/1000 person years (PYs), P = .03). In treatment-naïve patients with BD, lithium initiation was associated with a decreased SH/SA-incidence (from 12 to 7 incidents per 1000 PYs, P <.01). In the reverse mirror-image design, lamotrigine discontinuation was associated with a decreased SH/SA-incidence for all patients (from 27 to 14 incidents per 1000 PYs, P = .03). In a secondary analysis, not restricted to patients with BD, lithium initiation was associated with a decreased SH/SA-incidence (from 16 to 11 events/1000 PYs, P <.01) and lithium discontinuation with an increased SH/SA-incidence in males (from 6 to 10 incidents per 1000 PYs, P = .03).
Limitations
Time-variant confounders may influence the results and may yield false positive (mimicking either a harmful or a protective effect) or false negative findings (no effect).
Conclusion
The present findings suggest that lithium and valproate may protect against self-harm and suicide attempts in bipolar disorder.
Language: en |