Suicidal Risks during Treatment of Bipolar Disorder Patients with Lithium versus Anticonvulsants

The aim of this study was to compare suicidal risks during long-term treatment of bipolar disorder (BPD) patients with lithium versus anticonvulsants (ACs). Medline (R) searching identified 6 reports of direct comparisons of patients diagnosed with BPD by modern criteria, treated :6 months with lithium versus ACs (carbamazepine, divalproex, lamotrigine), with non-zero risk of suicide or attempts in at least one study-arm. We extracted rates (events/persons/exposure time) for each treatment arm, and applied random-effects meta-analysis to determine pooled risk ratio, risk difference, and their 95% confidence intervals (CI). Overall, rates of suicidal acts were 2.86-times (95% Cl: 2.29-3.57; p<0.0001) higher during treatment with ACs versus lithium, and no AC emerged as clearly superior to the others. Comparisons of suicidal risks during treatment with lithium versus ACs remain rare and methodologically limited, but favor lithium and encourage further study in this era of growing regulatory concern about possible adverse effects of ACs.