This study aimed to investigate the relationship between mood stabilizing treatments and the risk of suicide attempts in patients with bipolar disorder (BPD). It included 14,087 patients who received mood stabilizing agents between 2001 and 2020, identifying 1,316 patients who attempted suicide during the observation period. The study found that the risk of suicide attempts was elevated 14 days before treatment initiation, with the risk diminishing after treatment began. Lithium and antiepileptics were associated with a reduced risk of suicide attempts, while antipsychotics had a mixed effect, showing a higher risk in the pre-exposure period but a smaller risk during treatment. An increased risk of suicide attempts was observed when mood stabilizers were discontinued.

The study suggests that mood stabilizing agents are not causally linked to an increased risk of suicide attempts. In fact, lithium and antiepileptics seem to offer protective effects against suicidality, while antipsychotics showed mixed results. Importantly, the risk was elevated when treatment was discontinued, likely due to symptom relapse. These findings highlight the importance of careful monitoring for signs of suicide ideation when considering the cessation or withholding of mood stabilizing treatments in patients with bipolar disorder.

Reference: Ng VWS, Leung MTY, Chan EW, et al. Association between the mood stabilizing treatment of bipolar disorder and risk of suicide attempts: A self-controlled case series study. Psychiatry Res. 2023 Jul;325:115236. doi: 10.1016/j.psychres.2023.115236. Epub 2023 May 7. PMID: 37172400.