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Cited by 45Bipolar Disorder and TreatmentSuicide and Self-Harm StudiesSchizophrenia research and treatment

Suicide attempts in veterans with bipolar disorder during treatment with lithium, divalproex, and atypical antipsychotics

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Ahearn, Eileen P., Chen, Peijun, Hertzberg, Michael, Cornette, Michelle, Suvalsky, Lori, Cooley-Olson, Deanna, Swanlund, Jamie, Eickhoff, Jens +2 more·2013·Journal of Affective Disorders
DOI 10.1016/j.jad.2012.07.015PMC PMC4174317
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Abstract

Suicide attempt rates were assessed in 1306 subjects in this 6 year retrospective study of Bipolar disorder. Participants were Veterans from 5 different Veterans Administration Hospitals who met criteria for bipolar type 1 or 2 and who had at least one prescription for lithium or divalproex or both during the study period. This study focused on the impact of atypical antipsychotics on the suicide attempt rate when used in addition to or in place of lithium or divalproex. Medication exposure was calculated using computerized pharmacy records. Suicide attempts were established through chart review including emergency room records, inpatient records, and outpatient records. There were a total of 117 suicide attempts and 2 suicide completions during the study period. Most attempts (59%) occurred when patients were on no medications. Nearly 90% of subjects spent an average of 45 months during the 6 year period on none of the aforementioned medications. The lowest percentage of suicide attempts (15%) occurred while on lithium, 21% while on divalproex and 24% while on atypical antipsychotics. When total months of exposure were taken into account, the lowest attempt rate occurred on lithium plus divalproex (6.3 attempts per 10,000 months of exposure), followed by divalproex alone (7.0 attempts/10,000 months of exposure), and lithium alone (7.7 attempts per 10,000 months of exposure). Patients on atypical antipsychotics alone had an attempt rate of 26.1 attempts per 10,000 months of exposure. In this study, lithium and divalproex provided protection against suicide attempts. Results need to be replicated in future prospective studies and clearly strategies for improving medication compliance among veterans are warranted.

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  • Most of the data supporting lithium's utility in preventing suicide related outcomes derives from observational studies of patients followed clinically with lithium, and some studies have reported conflicting data.

    “However, most of the data supporting its utility in preventing suicide related outcomes derives from observational studies of patients followed clinically with lithium 292,293 and some studies have reported conflicting data 294 .”

    From Suicide and suicide risk (2019) · cites this paper as [293]

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Authors
Ahearn, E. P., Chen, P., Hertzberg, M., Cornette, M., Suvalsky, L., Cooley-Olson, D., Swanlund, J., Eickhoff, J., Becker, T., & Krahn, D.
Affiliations
  • University of Wisconsin–Madison (US)
  • Louis Stokes Cleveland VA Medical Center (US)
  • Duke Medical Center (US)
  • Medical College of Wisconsin (US)
  • Minneapolis VA Medical Center (US)
  • William S. Middleton Memorial Veterans Hospital (US)
ORCID
Venue
Journal of Affective Disorders
Publisher
Elsevier BV
Published
2013-02
Volume
145
Issue
1
Pages
77-82
ISSN
0165-0327 (ISSN-L)
DOI
10.1016/j.jad.2012.07.015
PMC
PMC4174317
OpenAlex
W2032246956
Cited by
45
References
35
Citations by year
2026: 3 · 2025: 3 · 2024: 1 · 2023: 1 · 2022: 1 · 2021: 7 · 2020: 3 · 2019: 1 · 2018: 5 · 2017: 2 · 2016: 6 · 2015: 3 · 2014: 4 · 2013: 5
FWCI
2.73
Type
journal article
Language
en
Open access
Licence
www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations
  • Journal of Affective Disorders (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • National Institutes of Health (UL1TR000427)
  • National Center for Advancing Translational Sciences
Topics
  • Health Sciences › Medicine › Psychiatry and Mental health › Bipolar Disorder and Treatment
  • Social Sciences › Psychology › Clinical Psychology › Suicide and Self-Harm Studies
  • Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
Keywords
suicide attempts, bipolar disorder, veterans, lithium, divalproex, atypical antipsychotics, drug safety, medication adherence, suicide prevention
MeSH terms
Adult, Bipolar Disorder, Female, Humans, Male, Middle Aged, Retrospective Studies, Suicide, Attempted, Antipsychotic Agents, Valproic Acid, Veterans, Lithium Compounds

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