Clinical Guidance: Lithium and Valproate Treatment—A Prospective Comparison of Effects on Suicide Attempts
A 2.5-year randomized trial of lithium versus valproate treatment for patients with bipolar disorder who had made a previous suicide attempt found no difference in subsequent attempts between the two treatment groups, as reported by Oquendo et al. (p. 1050). Fourteen of the 35 participants made at least one suicide attempt, six from the lithium group and eight from the valproate group. While the data seem to exclude a very large effect of drug (figure), the study does not have sufficient size to exclude smaller, but perhaps clinically significant effects. An editorial by Perlis (p. 1009) points out that the high rates of suicide attempts in both medication groups underscore the challenge of caring for very suicidal patients.