This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citing articles on HighWire  • Citing articles on ISI (5)  • Contact me when this article is cited  Related Content  • Related articles  • Similar articles in JAMA  Topic Collections  • Psychiatry  • Adverse Effects  • Alert me on articles by topic

	Since this article does not have an abstract, we have provided the first 132 words of the full text and any section headings.

To the Editor: In their retrospective study, Dr Goodwin and colleagues¹ reported that lithium was associated with a lower risk of suicide attempt and suicide death than was divalproex among patients with bipolar disorder.

We are concerned that the authors did not measure risk factors for suicide in bipolar disorder, such as history of suicide attempts, mixed episodes, mood cycling in the episode, depression, severe anxiety, personality disorders, or comorbid substance abuse.^2-4 Furthermore, although the authors claimed that lithium might exert an antisuicide effect, patients who received lithium did not have significantly lower event rates for suicide attempts and deaths than patients who received no drug treatment. In one of the authors' samples, patients who received lithium had a higher risk of suicide attempts and deaths than those who received no treatment.

Charles Bowden, MD
bowdenc@uthscsa.edu
Department of Psychiatry
University of Texas Health Science Center
San Antonio

Jan Fawcett, MD
Department of Psychiatry
Rush University Medical Center
Chicago, Ill

1. Goodwin FK, Fireman B, Simon GE, Hunkeler EM, Lee J, Revicki D. Suicide risk in bipolar disorder during treatment with lithium and divalproex. JAMA. 2003;290:1467-1473. FREE FULL TEXT 2. Fawcett J, Scheftner WA, Fogg L, et al. Time-related predictors of suicide in major affective disorder. Am J Psychiatry. 1990;147:1189-1194. FREE FULL TEXT 3. Goodwin FK, Ghaemi SN. The impact of mood stabilizers on suicide in bipolar disorder: a comparative analysis. CNS Spectr. 2000;5(suppl 1):12-18. 4. American Psychiatric Association. Practice guideline for the treatment of patients with bipolar disorder (revision). Am J Psychiatry. 2002;159(4 Suppl):1-50. PUBMED

Letters Section Editor: Stephen J. Lurie, MD, PhD, Senior Editor.

JAMA. 2004;291:939.

RELATED ARTICLES

Pharmacotherapy and Risk of Suicidal Behaviors Among Patients With Bipolar Disorder
Boghos I. Yerevanian, Ralph J. Koek, and Jamie D. Feusner
JAMA. 2004;291(8):939.
EXTRACT | FULL TEXT  

Pharmacotherapy and Risk of Suicidal Behaviors Among Patients With Bipolar Disorder—Reply
Frederick K. Goodwin, Greg Simon, Dennis Revicki, Enid Hunkeler, Bruce Fireman, and Janelle Lee
JAMA. 2004;291(8):940.
EXTRACT | FULL TEXT  

Suicide Risk in Bipolar Disorder During Treatment With Lithium and Divalproex
Frederick K. Goodwin, Bruce Fireman, Gregory E. Simon, Enid M. Hunkeler, Janelle Lee, and Dennis Revicki
JAMA. 2003;290(11):1467-1473.
ABSTRACT | FULL TEXT  

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Suicide Risk in Patients Treated With Lithium
Kessing et al.
Arch Gen Psychiatry 2005;62:860-866.
ABSTRACT | FULL TEXT