Suicidal ideation and pharmacotherapy among STEP-BD patients.
OBJECTIVE
Little is known about the effects of lithium on suicidal ideation or about the possible antisuicidal effects of divalproex, second-generation antipsychotics, or antidepressants among persons with bipolar disorder.


METHODS
Using a cross-sectional design, the authors examined patterns of psychotropic drug use relative to suicidal ideation among 1,000 patients with bipolar disorder in the National Institute of Mental Health's Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD).


RESULTS
The presence of suicidal ideation was similar between patients who were taking any lithium and those who were not (22.2 percent and 25.8 percent, respectively) and between those who were taking any divalproex and those who were not (20.3 percent and 21.5 percent). Suicidal ideation was significantly more prevalent among patients who were taking a second-generation antipsychotic than those who were not (26 percent and 17 percent) and those who were taking an antidepressant and those who were not (25 percent and 14 percent). After other variables had been controlled for, lithium prescriptions were significantly more common among patients who had suicidal ideation.


CONCLUSIONS
Among patients with bipolar disorder who have suicidal ideation, antidepressants and second-generation antipsychotics appear to be prescribed by community practitioners more often than other medications, with lithium reserved for those with more severe illness characteristics.
Goldberg
Joseph F
JF
Affective Disorders Program, Silver Hill Hospital, 208 Valley Road, New Canaan, Connecticut 06840, and Department of Psychiatry, University of Colorado School of Medicine, Denver, USA. jfgoldberg@yahoo.com
Allen
Michael H
MH
Miklowitz
David A
DA
Bowden
Charles L
CL
Endick
Carrie J
CJ
Chessick
Cheryl A
CA
Wisniewski
Stephen R
SR
Miyahara
Sachiko
S
Sagduyu
Kemal
K
Thase
Michael E
ME
Calabrese
Joseph R
JR
Sachs
Gary S
GS
D000328:Adult; D000928:Antidepressive Agents / Q000009:adverse effects*; D018687:Antidepressive Agents, Second-Generation / Q000627:therapeutic use*; D018692:Antimanic Agents / Q000627:therapeutic use*; D001714:Bipolar Disorder / Q000188:drug therapy*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008094:Lithium / Q000627:therapeutic use*; D016015:Logistic Models; D008297:Male; D010347:Patient Care Planning; D013405:Suicide / Q000523:psychology* / Q000706:statistics & numerical data; D014481:United States; D014635:Valproic Acid / Q000627:therapeutic use*; D000092864:Suicide Prevention
D000928:Antidepressive Agents; D018687:Antidepressive Agents, Second-Generation; D018692:Antimanic Agents; D014635:Valproic Acid; D008094:Lithium