Article contents
The Impact of Mood Stabilizers on Suicide in Bipolar Disorder: A Comparative Analysis
Published online by Cambridge University Press: 07 November 2014
Abstract
Which mood stabilizers are the most effective in reducing suicide rates in patients with bipolar disorder? This paper reviews the literature and compares the data on two types of mood-stabilizing agents, lithium and anticonvulsants. Compared with the large amount of data on lithium, there is surprising little information available on the effects of anticonvulsants on mortality in manic-depressive illness. Each was also assessed in terms of suicide risk factors such as depression and mixed episodes, rapid cycling, substance abuse, anxiety and panic, and central serotonergic function. Only two studies that provide data demonstrating anticonvulsant efficacy in preventing suicide in bipolar disorder are available, and the data are incomplete at best. Further research in this area should include an emphasis on the outcome of mortality in patients treated with any of the anticonvulsants or with lithium-anticonvulsant combinations.
Information
- Type
- Academic Supplement
- Information
- CNS Spectrums , Volume 5 , supplement S1: Suicide: Risk Assessment and Pharmacologic Intervention , February 2000 , pp. 12 - 18
- Copyright
- Copyright © Cambridge University Press 2000
References
REFERENCES
1.Goodwin, FK, Jamison, KR. Manic Depressive Illness. New York, NY: Oxford University Press; 1990.Google Scholar
2.Fawcett, J, Scheftner, W, Clark, D, Hedeker, D, Gibbons, R, Coryell, W. Clinical predictors of suicide in patients with major affective disorders: a controlled prospective study. Am J Psychiatry. 1987;144:35–40.Google ScholarPubMed
3.Fawcett, J, Scheftner, W, Fogg, L, et al.Time-related predictors of suicide in major affective disorder. Am J Psychiatry. 1990;147:1189–1194.Google ScholarPubMed
4.Harrow, M, Goldberg, JF, Grossman, LS, Meltzer, HY. Outcome in manic disorders: a naturalistic follow-up study. Arch Gen Psychiatry. 1990;47:665–671.CrossRefGoogle ScholarPubMed
5.Tohen, M, Waternaux, CM, Tsuang, MT. Outcome in mania: a 4-year prospective follow-up of 75 patients utilizing survival analysis. Arch Gen Psychiatry. 1990;47:1106–1111.CrossRefGoogle Scholar
6.Sachs, GS, Lafer, B, Truman, CJ, Noeth, M, Thibault, AB. Lithium monotherapy: miracle, myth and misunderstanding. Psychiatr Ann. 1994;24:299–306.CrossRefGoogle Scholar
7.Page, C, Benaim, S, Lappin, F. A long-term retrospective follow-up study of patients treated with prophylactic lithium carbonate. Br J Psychiatry. 1987;150:175–179.CrossRefGoogle ScholarPubMed
8.Wehr, TA, Goodwin, FK. Rapid cycling in manic-depressives induced by tricyclic antidepressants. Arch Gen Psychiatry. 1979;36:555–559.CrossRefGoogle ScholarPubMed
9.Wehr, TA, Turner, EH, Shimada, JM, Lowe, CH, Barker, C, Leibenluft, E. Treatment of a rapidly cycling bipolar patient by using extended bed rest and darkness to stabilize the timing and duration of sleep. Biol Psychiatry. 1998;43:822–828.CrossRefGoogle ScholarPubMed
10.Schou, M. The effect of prophylactic lithium treatment on mortality and suicidal behavior: a review for clinicians. J Affect Disord. 1998;50:253–259.Google ScholarPubMed
11.Coppen, A, Farmer, R. Suicide mortality in patients on lithium maintenance therapy. J Affect Disord. 1998;50:261–267.CrossRefGoogle ScholarPubMed
12.Tondo, L, Jamison, K, Baldessarini, R. Effect of lithium maintenance on suicidal behavior in major mood disorders. In: Stoff, D, Mann, J, eds. The Neurobiology of Suicide: From the Bench to the Clinic. Vol 836. New York: The New York Academy of Sciences; 1997:339–351.Google Scholar
13.Practice guidelines for the treatment of patients with bipolar disorder: American Psychiatric Association. Am J Psychiatry. 1994;151(12 suppl):1–36.CrossRefGoogle Scholar
14.Keck, PE Jr, McElroy, SL, Nemeroff, CB. Anticonvulsants in the treatment of bipolar disorder. J Neuropsychiatry Clin Neurosci. 1992;4:395–405.Google ScholarPubMed
15.Post, RM. Non-lithium treatment for bipolar disorder. J Clin Psychiatry. 1990;51(suppl):9–16.Google ScholarPubMed
16.Placidi, GF, Lenzi, A, Lazzerini, F, Cassano, GB, Akiskal, HS. The comparative efficacy and safety of carbamazepine versus lithium: a randomized, double-blind 3-year trial in 83 patients. J Clin Psychiatry. 1986;47:490–494.Google ScholarPubMed
17.Watkins, SE, Callender, K, Thomas, DR, Tidmarsh, SF, Shaw, DM. The effect of carbamazepine and lithium on remission from affective illness. Br J Psychiatry. 1987;150:180–182.CrossRefGoogle ScholarPubMed
18.Lusznat, RM, Murphy, DP, Nunn, CM. Carbamazepine vs lithium in the treatment and prophylaxis of mania. Br J Psychiatry. 1988;153:198–204.CrossRefGoogle ScholarPubMed
19.Bellaire, W, Demisch, K, Stoll, K. Carbamazepine vs lithium in prophylaxis of recurrent affective disorders. Psychopharmacology. 1988;96(suppl):287.Google Scholar
20.Coxhead, N, Silverstone, T, Cookson, J. Carbamazepine versus lithium in the prophylaxis of bipolar affective disorder. 1992;85:114–118.Google ScholarPubMed
21.Bowden, CL. Maintenance treatments for bipolar disorder (abstract). Presented at the 37th annual meeting of the New Clinical Drug Evaluation Unit, Boca Raton, Florida, May 27-30, 1997.Google Scholar
22.Bowden, CL. Effects on suicidality of divalproex, lithium, and placebo in randomized one-year maintenance treatment of bipolar disorder. Presented at the 38th annual meeting of the New Clinical Drug Evaluation Unit, Boca Raton, Florida, June 10-13, 1998. Abstract.Google Scholar
23.American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 3rd ed. Washington, DC: American Psychiatric Association; 1980.Google Scholar
24.Thies-Flechtner, K, Muller-Oerlinghausen, B, Seibert, W, Walther, A, Greil, W. Effect of prophylactic treatment on suicide risk in patients with major affective disorders: data from a randomized prospective trial. Pharmacopsychiatry. 1996;29:103–107.CrossRefGoogle ScholarPubMed
25.Isometsa, ET, Henriksson, MM, Aro, HM, Lonnqvist, JK. Suicide in bipolar disorder in Finland. Am J Psychiatry. 1994;151:1020–1024.Google ScholarPubMed
26.World Health Organization. International Statistical Classification fo Diseases and Related Health Problems. 10th ed. Geneva, Switzerland: World Health Organization; 1992.Google Scholar
27.American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 3rd ed rev. Washington, DC: American Psychiatric Association; 1987.Google Scholar
28.Rybakowski, J, Chlopocka-Wozniak, M, Kapelski, Z, Strzyzewski, W. The relative prophylactic efficacy of lithium against manic and depressive recurrences in bipolar patients. Int Pharmacopsychiatry. 1980;15:86–90.CrossRefGoogle ScholarPubMed
29.Poole, AJ, James, HD, Hughes, WC. Treatment experiences in the lithium clinic at St Thomas Hospital. J R Soc Med. 1978;71:890–894.CrossRefGoogle ScholarPubMed
30.Holinger, PC, Wolpert, EA. A ten-year follow-up of lithium use. Ill Med J. 1979;156:99–104.Google ScholarPubMed
31.Quitkin, FM, Kane, J, Rifkin, A, Ramos-Lorenzi, JR, Nayak, DV. Prophylactic lithium carbonate with and without imipramine for bipolar 1 patients: a double-blind study. Arch Gen Psychiatry. 1981;38:902–907.CrossRefGoogle ScholarPubMed
32.Mandell, AJ, Knapp, S. Asymmetry and mood-emergent properties of serotonin regulation. Arch Gen Psychiatry. 1979;36(8 Spec No):909–916.CrossRefGoogle ScholarPubMed
33.Roy, A, Virkkunen, M, Linnoila, M. Monoamines, glucose metabolism, aggression towards self and others. Int J Neurosci. 1988;41:261–264.CrossRefGoogle ScholarPubMed
34.Higley, JD, Mehlman, PT, Taub, DM, et al.Cerebrospinal fluid monoamine and adrenal correlates of aggression in free-ranging rhesus monkeys. Arch Gen Psychiatry. 1992;49:436–441.CrossRefGoogle ScholarPubMed
35.Van Praag, HM. Serotonergic dysfunction and aggression control. Psychol Med. 1991;21:15–19.CrossRefGoogle ScholarPubMed
36.Treiser, SL, Cascio, CS, O'Donohue, TL, Thoa, NB, Jacobowitz, DM, Kellar, KJ. Lithium increases serotonin release and decreases serotonin receptors in the hippocampus. Science. 1981;213:1529–1531.CrossRefGoogle ScholarPubMed
37.Ballenger, JC, Post, RM. Therapeutic effects of carbamazepine in affective illness: a preliminary report. Commun Psychopharmacol. 1978;2:159–75.Google ScholarPubMed
38.Okuma, T. Therapeutic and prophylactic effects of carbamazepine in bipolar disorders. Pyschiatr Clin North Am. 1983;6:157–174.CrossRefGoogle ScholarPubMed
39.Calabrese, JR, Delucchi, GA. Spectrum of efficacy of valproate in 55 patients with rapid-cycling bipolar disorder. Am J Psychiatry. 1990;147:431–434.Google ScholarPubMed
40.Davis, LL, Kabel, D, Patel, D, et al.Valproate as an antidepressant in major depressive disorder. Psychopharmacol Bull. 1996;32:647–652.Google ScholarPubMed
41.Bowden, CL, Brugger, AM, Swann, AC, et al.Efficacy of divalproex vs lithium and placebo in the treatment of mania: the Depakote Mania Study Group. JAMA. 1994;271:918–924.CrossRefGoogle ScholarPubMed
42.Freeman, TW, Clothier, JL, Pazzaglia, P, Lesem, MD, Swann, AC, Roache, A. Valporate in mania: a double-blind study. Paper presented at: 143rd annual meeting of the American Psychiatric Association; New York, NY. May 1990.Google Scholar
43.Di Costanzo, E, Schifano, F. Lithium alone or in combination with carbamazepine for the treatment of rapid-cycling bipolar affective disorder. Acta Psychiatr Scand. 1991;83:456–459.CrossRefGoogle ScholarPubMed
44.Calabrese, JR, Woyshville, MJ, Kimmel, SE, Rapport, DJ. Predictors of valproate response in bipolar rapid cycling. J Clin Psychopharmacol. 1993;13:280–283.CrossRefGoogle ScholarPubMed
45.Barraclough, B, Bunch, J, Nelson, B, Sainsbury, P. A hundred cases of suicide: clinical aspects. Br J Psychiatry. 1974;125:355–373.CrossRefGoogle ScholarPubMed
46.Brady, KT, Sonne, SC. The relationship between substance abuse and bipolar disorder. J Clin Psychiatry. 1995;56(suppl 3):19–24.Google ScholarPubMed
47.De Deyn, P, Macdonald, RL. Effects of antiepileptic drugs on GABA responses and on reduction of GABA responses by PTZ and DMCM on mouse neurons in cell culture. Epilepsia. 1989;30:17–25.CrossRefGoogle ScholarPubMed
48.Concas, A, Mascia, M, Sanna, E, Santoro, G, Serra, M, Biggio, G. “In vivo” administration of valproate decreases t-[35S]butylbicyclophosphorothionate binding in the rat brain. Naunyn Schmiedebergs Arch Pharmacol. 1991;343:296–300.CrossRefGoogle ScholarPubMed
49.Motohashi, N. GABA receptor alterations after chronic lithium administration: comparison with carbamazepine and sodium valproate. Prog Neuropsychopharmacol Biol Psychiatry. 1992;16:571–579.Google ScholarPubMed
50.Sachs, GS. Use of clonazepam for bipolar affective disorder. J Clin Psychiatry. 1990;51(suppl):31–34.Google ScholarPubMed
51.Maes, M, Calabrese, J, Jayathilake, K, Meltzer, HY. Effects of subchronic treatment with valproate on L-5-HTP-induced cortisol responses in mania: evidence for increased central serotonergic neurotransmission. Psychiatry Res. 1997;71:67–76.CrossRefGoogle ScholarPubMed
52.Shiah, IS, Yatham, LN, Lam, RW, Zis, AP. Effects of divalproex sodium on 5-HTIA receptor function in healthy human males: hypothermic, hormonal, and behavioral responses to ipsapirone. Neuropsychopharmacology. 1997;17:382–390.CrossRefGoogle Scholar
53.Singh, L, Field, MJ, Ferris, P, et al.The antiepileptic agent gabapentin (Neurontin) possesses anxiolytic-like and antinociceptive actions that are reversed by D-serine. Psychopharmacology (Berl). 1996;127:1–9.CrossRefGoogle ScholarPubMed
54.Ryback, RS, Brodsky, L, Munasifi, F. Gabapentin in bipolar disorder (letter). J Neuropsychiatry Clin Neurosci. 1997;9:301.CrossRefGoogle Scholar
55.Ghaemi, SN, Katzow, JJ, Desai, SP, Goodwin, FK. Gabapentin treatment of mood disorders: a preliminary study. J Clin Psychiatry. 1998;59:426–429.CrossRefGoogle ScholarPubMed
56.Frye, M, Ketterer, T, Kimbrell, T, Coralocatelli, G, Dunn, R, Post, R. Lamotrigine vs gabapentin monotherapy in unipolar and bipolar illness. In: Program and abstracts of the annual meeting of the American Psychiatric Association; May 17-22, 1997; San Diego, Calif. Abstract.Google Scholar
57.Pande, A. Adjunctive treatment with gabapentin for bipolar disorder. In: Program and abstracts of the 3rd International Conference on Bipolar Disorder; June 17-19, 1999; Pittsburgh, Pa.Google Scholar
58.Sporn, J, Sachs, G. The anticonvulsant lamotrigine in treatment-resistant manic-depressive illness. J Clin Psychopharmacol. 1997;17:185–189.CrossRefGoogle ScholarPubMed
59.Bowden, CL, Calabrese, JR, McElroy, SL, et al.The efficacy of lamotrigine in rapid cycling and non-rapid cycling patients with bipolar disorder. Biol Psychiatry. 1999;45:953–958.CrossRefGoogle ScholarPubMed
60.Calabrese, JR, Bowden, CL, Sachs, GS, Ascher, JA, Monaghan, E, Rudd, GD. A double-blind placebo-controlled study of lamotrigine monotherapy in outpatients with bipolar I depression: Lamictal 602 Study Group. J Clin Psychiatry. 1999;60:79–88.CrossRefGoogle ScholarPubMed
61.Calabrese, J, Shelton, J, Keck, P, McElroy, S, Werkner, J. Topiramate in severe treatment-refractory mania. In: Program and abstracts of the 151st annual meeting of the American Psychiatric Association; May 30-June 4, 1998; Toronto, Canada.Google Scholar
62.Rosenfeld, W. Topiramate: a review of preclinical, pharmacokinetic, and clinical data. Clin Ther. 1997;6:1294–1308.CrossRefGoogle Scholar
63.Post, RM, Frye, MA, Leverich, GS, Denicoff, KD. The role of complex combination therapy in the treatment of refractory bipolar illness. CNS Spectrums. 1998;3:66–86.CrossRefGoogle Scholar
- 1
- Cited by
