TUESDAY, Sept. 16 2003(HealthDayNews) -- The most widely prescribed treatment for manic depression in the United States carries a suicide risk that's as much as three times higher than that for lithium, a new study has found.

Lithium was the first drug approved to treat manic depression -- more appropriately called bipolar disorder -- a whipsawing of emotions that affects about 2 million Americans. Since the late 1990s, doctors have preferred divalproex, another mood stabilizer.

But in a head-to-head study of the two therapies in more than 20,600 patients, researchers found people on the newer drug attempted suicide, and succeeded, far more frequently than did those on lithium. The findings appear in the Sept. 17 issue of the Journal of the American Medical Association.

Suicide is strikingly common among patients with bipolar disorder, occurring 10 to 20 times more often than in the general population. Part of that difference reflects that people with the illness are much more effective at attempting suicide than others, including patients with other forms of emotional distress.

Lithium has long been known to reduce suicidal tendencies in bipolar patients. The drug stabilizes their mood and relieves severe depression, the state during which most suicide attempts are made, says Dr. David L. Dunner, director of the University of Washington's Center for Anxiety and Depression in Seattle.

Other mood drugs, including divalproex and carbamazepine, even out mood swings, but how well they combat depression isn't clear, says Dunner. "Many drugs are effective against the highs, but the depression side of the illness, which is where the suicides occur, hasn't been well studied," he says.

The latest study compared suicide attempts and successes in 20,638 people over age 14 with bipolar disorder belonging to two major health plans in Washington state and California. About 12,500 had ever taken divalproex and 11,500 had taken lithium. A few had also used carbamazepine, though the numbers were too small to make sound comparisons.

Fifty-three people committed suicide during the study period, and 338 were hospitalized for attempting to take their own life. The rate of suicide was 2.7 times greater in patients taking divalproex than in those taking lithium. Suicide attempts were nearly twice as frequent, too.

Dr. Leonardo Tondo, a psychiatrist and lecturer at Harvard Medical School in Boston, says lithium's ability to prevent suicide is impressive and proven. "In medicine only very, very effective drugs can have that kind of reduction," says Tondo, co-author of an editorial accompanying the journal article. "Lithium seems to prevent suicide much, much better than any other available treatment."

Tondo laments that suicide is still viewed largely as a sociological problem rather than as the ultimate manifestation of psychological distress. But nine in 10 people who commit suicide have some form of mental illness, he says.

http://hdlighthouse.org/treatment-care/treatment/drugs/related/updates/0060lithium.phtml

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