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February 25, 2004

Pharmacotherapy and Risk of Suicidal Behaviors Among Patients With Bipolar Disorder

Author Affiliations

Letters Section Editor: Stephen J. Lurie, MD, PhD, Senior Editor.

JAMA. 2004;291(8):939-940. doi:10.1001/jama.291.8.939-b

To the Editor: We have several concerns about the study by Dr Goodwin and colleagues.1 First, the lack of clinical record review makes it difficult to attribute the findings entirely to the effects of the drugs, especially since nonadherence is common among patients with bipolar disorder. We suspect that pharmacy records may not correlate well with documentation by physician progress notes. Thus, durings periods that Goodwin et al counted as exposure to medication, some patients may have actually been receiving no medication, with an associated increase in risk of suicide. This phenomenon has been described for rapid discontinuation of lithium.2

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