Real-world effectiveness of mood stabilizers on self-harm and suicide attempts in patients with bipolar disorder: A 2-year mirror-image study

Journal of Affective Disorders Reports

Jimmi Nielsen¹  Søren Dinesen Østergaard²  Christopher Rohde³  Oskar Hougaard Jefsen³ 

[1]Corresponding author at: Department of Affective Disorders, Aarhus University Hospital–Psychiatry, Palle Juul Jensens Boulevard 175, 8200 Aarhus, Denmark.

[2]Department of Clinical Medicine, Aarhus University, Denmark

[3]Department of Affective Disorders, Aarhus University Hospital Psychiatry, Denmark

关键词: Pharmacoepidemiology;    Bipolar disorder;    Self-injurious behaviour;    Suicide;    Antimanic agents;   

DOI  :  

来源: DOAJ

【 摘 要 】

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.

【 授权许可】

Unknown