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February 25, 2004

Pharmacotherapy and Risk of Suicidal Behaviors Among Patients With Bipolar Disorder—Reply

Author Affiliations

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

JAMA. 2004;291(8):939-940. doi:10.1001/jama.291.8.940-a

In Reply: Drs Bowden and Fawcett point out the many potential sources of bias or confounding in our comparison of lithium and divalproex. We did in fact measure and adjust for comorbid substance abuse and anxiety disorder, but we lacked data on many other potential risk factors. This is an inevitable shortcoming of large epidemiologic studies based on administrative claims data. Our analyses do indicate that 1 year of treatment was a far stronger predictor of drug choice than any clinical characteristics of individual patients, arguing against significant confounding by indication.

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