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Pharmacotherapy and Risk of Suicidal Behaviors Among Patients With Bipolar Disorder—Reply
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In Reply: Drs Bowden and Fawcett point out the many potential sources of bias or confounding in our comparison of lithium and divalproex. We did in fact measure and adjust for comorbid substance abuse and anxiety disorder, but we lacked data on many other potential risk factors. This is an inevitable shortcoming of large epidemiologic studies based on administrative claims data. Our analyses do indicate that 1 year of treatment was a far stronger predictor of drug choice than any clinical characteristics of individual patients, arguing against significant confounding by indication.
Bowden and Fawcett are also concerned about our comparison of lithium treatment with periods of no treatment. Our data actually show slightly higher risk of serious attempt or suicide death during times without mood stabilizer treatment (bottom rows of Table 2). As we pointed out, however, this comparison is much more subject to bias than is the comparison of . . . [Full Text of this Article]
Frederick K. Goodwin, MD
fgoodwin@mfa.gwu.edu
Department of Psychiatry
George Washington University Medical Center
Washington, DC
Greg Simon, MD
Center for Health Studies
Group Health Cooperative
Seattle, Wash
Dennis Revicki, PhD
MEDTAP International
Bethesda, Md
Enid Hunkeler, MA;
Bruce Fireman, MA;
Janelle Lee, MHA, DrPH
Division of Research
Kaiser Permanente Medical Care Program
Oakland, Calif
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