Treatment with lithium carbonate may decrease risk for drug-related suicidal behavior and ideation as well as hostility and aggression in the setting of bipolar disorder. These findings were published in the Journal of Psychiatric Research.
Investigators from the Aichi Gakuin University in Japan sourced data for this study from the Japanese Adverse Drug Event Report (JADER) database. Reports of drug-related adverse suicidal and behavioral events among patients with bipolar disorders (N=3521) were evaluated for potential risk factors.
Patients ranged in age from 10 to 99 years, 1544 used lithium carbonate, 839 sodium valproate, 503 quetiapine fumarate, 470 aripiprazole, 316 carbamazepine, and 239 risperidone.
In total, there were 134 reports of suicidal behaviors and 248 reports of hostility or aggression. The suicide events included attempts (n=71), ideation (n=34), death (n=27), and depression (n=2). The most common behavioral events were mania (n=109), hypomania (n=16), and aggression (n=14).
For suicide-related events, risk was associated with bipolar II disorder (aOR, 4.55; P =.0007), akathisia onset (aOR, 3.05; P <.0001), the akathisia-by-bipolar II interaction (aOR, 2.77; P =.0230), age <50 years (aOR, 1.75; P <.0001), aripiprazole use (aOR, 1.27; P =.0454), and being a man (aOR, 1.23; P =.0279).
For behavior-related events, risk was associated with being a man (aOR, 1.22; P =.0054).
Use of lithium carbonate decreased the risk for suicide-related events (aOR, 0.664; P =.0002) and behavior-related events (aOR, 0.823; P =.0091). Sodium valproate use also decreased the risk for aggression or hostility (aOR, 0.693; P =.0278).
This study may have included selection bias, as the JADER database is a spontaneous reporting system.
Study authors concluded, “The present study showed factors associated with the risks of suicidal behavior/ideation or hostility/aggression in bipolar disorders using the data extracted from the JADER database. Probably, our study is the first to represent that lithium carbonate decreased the risk of hostility/aggression in patients with bipolar disorders, and to reveal association of akathisia with the increased risks of suicidal behavior/ideation statistically.”
Uwai Y, Nabekura T. Risk factors for suicidal behavior/ideation and hostility/aggression in patients with bipolar disorders: an analysis using the Japanese Adverse Drug Event Report database. J Psychiatr Res. 2022;153:99-103. doi:10.1016/j.jpsychires.2022.07.005