September 17, 2003
Study Links Older Bipolar Drug to
Fewer Suicides

ithium, an old and inexpensive drug that has fallen out offavor with many psychiatrists, is better than the most commonly prescribed drug, Depakote, at preventing suicide inpeople who have manic-depressive illness, researchers arereporting.
People with the illness, also called bipolar disorder, swing backand forth between bleak spells of depression and periods of highexcitability that may run the gamut from euphoria to rage. From1.3 percent to 1.5 percent of people in the United States sufferfrom bipolar disorder, and their risk of committing suicide isestimated to be 10 to 20 times that of the rest of the population.
Perhaps because patients are more likely to seek medical helpwhen they are depressed than when they are manic, the disorderis often misdiagnosed at first as depression alone, butantidepressants are not the correct treatment for bipolar disorderand may in fact make it worse.
The new study, published today in The Journal of the AmericanMedical Association, found that patients taking Depakote were2.7 times as likely to kill themselves as those taking lithium.
Earlier studies by others had also found that lithium couldprevent suicide, but today's report is the first to compare suicideand attempted suicide rates in lithium and Depakote users. Thestudy was based on medical records of 20,638 patients aged 14 and older in Washington State and California who were treatedfrom 1994 to 2001.
Solvay Pharmaceuticals, a maker of lithium, paid for the study,but did not influence the findings or the way they were reported,the authors said.
The study included 53 actual suicides and 383 attempted suicidesthat led to hospitalization. But the researchers, as well asDepakote's manufacturer, cautioned that because this study wasbased only on patients' records, it was not conclusive.
Precisely how lithium might prevent suicide is not known,although it is believed to help regulate levels of serotonin, abrain chemical that influences mood.
"Lithium is clearly being underutilized," said Dr. Frederick K.
Goodwin, the senior author of the study and director of thepsychopharmacology research center at George WashingtonUniversity Medical Center. The drug can save lives, he said,adding, "The real tragedy is that a lot of young psychiatrists havenever learned to use lithium." Lithium, which can smooth out the highs and the lows of bipolardisorder, was first used in the 1950's, and in the 1970's was thefirst drug to be designated a "mood stabilizer" by the Food andDrug Administration. But the drug has been around for so longthat its patent has expired and generic versions exist, meaningthat lithium cannot generate substantial earnings for industry, Dr.
Goodwin said. Drug companies promote newer, more profitabledrugs like Depakote.
Some difficult cases referred to Dr. Goodwin turn out to bepeople who have never taken lithium because their psychiatrists — often under 40 — never thought of prescribing it. But Dr.
Goodwin also emphasized that lithium did not work for everyoneand that other drugs like Depakote were also needed.
Dr. John Leonard, a spokesman for Abbott Laboratories, themaker of Depakote, questioned the findings. Dr. Leonard said that studies looking back at patients' records were inherentlyflawed and not as reliable as studies in which patients wererandomly assigned by researchers to take one drug or the other. He said conclusions could not be drawn from the data, anddoctors should not base treatment decisions on it.
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