Yerevanian Boghos I, Koek Ralph J, Mintz Jim
Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, United States.
J Affect Disord. 2007 Nov;103(1-3):5-11. doi: 10.1016/j.jad.2007.05.019. Epub 2007 Jul 12.
The anti-suicidal benefit of lithium on suicidal behavior in bipolar disorder is well-established. Data are mixed on the effects of divalproex and carbamazepine.
Retrospective chart review study of 405 veterans with bipolar disorder followed for a mean of 3 years, with month by month review of clinical progress notes, and systematic assessment of current pharmacotherapy and suicide completion, attempt or hospitalization for suicidality. Comparison of suicide event rates (events/100 patient years) between mood stabilizers and during-vs-after discontinuation of mood stabilizers, with linear regression analysis for influence of potential confounding variables, and robust bootstrap confirmation analysis.
No completed suicides occurred during or after discontinuation of monotherapy. Rates of non-lethal suicidal behavior were similar during lithium (2.49), divalproex (4.67) and carbamazepine (3.80) monotherapies. There was a sixteen fold greater, highly statistically significant non-lethal suicidal event rate after discontinuation compared with during mood stabilizer monotherapy (55.89 vs. 3.48 events/100 patient years; Chi2=13.95; df=1; p<0.0002). On compared with off treatment differences were similar for the three different agents.
Treatments were uncontrolled in this naturalistic setting, and data were analyzed retrospectively.
Lithium and the anticonvulsants may show similar benefits in protecting bipolar patients from non-lethal suicidal behavior when careful analysis of clinical data is done to confirm medication adherence/non-adherence. Findings in this study were similar to those of a previous study that applied the same methodology in a private practice setting.
锂盐对双相情感障碍患者自杀行为的抗自杀作用已得到充分证实。丙戊酸和卡马西平的作用数据则存在分歧。
对405名双相情感障碍退伍军人进行回顾性病历审查研究，平均随访3年，逐月审查临床进展记录，并对当前药物治疗及自杀死亡、自杀未遂或因自杀倾向住院情况进行系统评估。比较心境稳定剂之间以及心境稳定剂停用期间与停用后自杀事件发生率（事件数/100患者年），采用线性回归分析潜在混杂变量的影响，并进行稳健的自抽样确认分析。
单一疗法治疗期间及停药后均未发生自杀死亡。锂盐（2.49）、丙戊酸（4.67）和卡马西平（3.80）单一疗法期间非致命性自杀行为发生率相似。与心境稳定剂单一疗法期间相比，停药后非致命性自杀事件发生率高出16倍，具有高度统计学意义（55.89对3.48事件/100患者年；χ2=13.95；自由度=1；p<0.0002）。三种不同药物的治疗与未治疗差异相似。
在这种自然环境中治疗未设对照，且数据为回顾性分析。
当对临床数据进行仔细分析以确认药物依从性/不依从性时，锂盐和抗惊厥药物在保护双相情感障碍患者免受非致命性自杀行为方面可能显示出相似的益处。本研究结果与之前在私人诊所环境中采用相同方法的研究结果相似。
