New 20,638 person study links lithium to fewer suicides
By DENISE GRADY NY Times, September 2003
Lithium, an old and inexpensive drug that has fallen out of favor
with many psychiatrists, is better than the most commonly
prescribed drug, Depakote, at preventing suicide in people who
have manic-depressive illness, researchers are reporting.
People with the illness, also called bipolar disorder, swing
back and forth between bleak spells of depression and periods of
high excitability that may run the gamut from euphoria to rage.
From 1.3 percent to 1.5 percent of people in the United States
suffer from bipolar disorder, and their risk of committing suicide
is estimated to be 10 to 20 times that of the rest of the
Perhaps because patients are more likely to seek medical help
when they are depressed than when they are manic, the disorder is
often misdiagnosed at first as depression alone, but antidepressants
are not the correct treatment for bipolar disorder and may in fact
make it worse.
The new study, published today in The Journal
of the American Medical Association, found that patients
taking Depakote were 2.7 times as likely to kill themselves as
those taking lithium. Earlier studies by others had also
found that lithium could prevent suicide, but today's report is
the first to compare suicide and attempted suicide rates in
lithium and Depakote users. The study was based on medical records
of 20,638 patients aged 14 and older in Washington State and
California who were treated from 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
suicides that led to hospitalization. But the researchers, as well
as Depakote's manufacturer, cautioned that because this study was
based 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, a
brain chemical that influences mood.
"Lithium is clearly being underutilized,"
said Dr. Frederick K. Goodwin, the senior author of the study and
director of the psychopharmacology research center at George
Washington University Medical Center. The drug can save lives, he
said, adding, "The real tragedy is that a lot of young
psychiatrists have never learned to use lithium."
Lithium, which can smooth out the highs and the lows of bipolar
disorder, was first used in the 1950's, and in the 1970's was the
first drug to be designated a "mood stabilizer" by the
Food and Drug Administration. But the drug has been around for so
long that its patent has expired and generic versions exist,
meaning that lithium cannot generate substantial earnings for
industry, Dr. Goodwin said. Drug companies promote newer, more
profitable drugs like Depakote.
Some difficult cases referred to Dr. Goodwin turn out to be
people 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 everyone and
that other drugs were needed..
Dr. John Leonard, a spokesman for Abbott Laboratories, the
maker of Depakote, questioned the findings. Dr. Leonard said that
studies looking back at patients' records were inherently flawed
and not as reliable as studies in which patients were randomly
assigned by researchers to take one drug or the other. He said
conclusions could not be drawn from the data, and doctors should
not base treatment decisions on it.
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