Letters Section Editor: Stephen J. Lurie,
MD, PhD, Senior Editor.
To the Editor: In their retrospective study,
Dr Goodwin and colleagues1 reported that
lithium was associated with a lower risk of suicide attempt and suicide death
than was divalproex among patients with bipolar disorder.
We are concerned that the authors did not measure risk factors for suicide
in bipolar disorder, such as history of suicide attempts, mixed episodes,
mood cycling in the episode, depression, severe anxiety, personality disorders,
or comorbid substance abuse.2- 4 Furthermore,
although the authors claimed that lithium might exert an antisuicide effect,
patients who received lithium did not have significantly lower event rates
for suicide attempts and deaths than patients who received no drug treatment.
In one of the authors' samples, patients who received lithium had a higher
risk of suicide attempts and deaths than those who received no treatment.
Bowden C, Fawcett J. Pharmacotherapy and Risk of Suicidal Behaviors Among Patients With Bipolar Disorder. JAMA. 2004;291(8):939–940. doi:10.1001/jama.291.8.939-a