Mood stabilizers, especially lithium, protect patients with bipolar disorder against suicide and all-cause mortality.
Putting It Into Practice
Compared to the general population, patients with bipolar disorder have premature mortality due to suicide, natural mortality (including chronic diseases), and all-cause mortality (including accidents and homicide).
The risk of suicide among patients with bipolar disorder is up to 30-fold higher than the general population; specifically, nearly 20% of premature deaths among patients with bipolar disorder are attributed to suicide and up to 60% of patients with bipolar disorder have attempted suicide at one time or another.
Natural mortality, however, is the leading cause of premature mortality among patients with bipolar disorder.
To better relieve the social burden and cost associated with premature mortality among patients with bipolar disorder, the determinants of premature mortality must be established and protective factors, such as mood stabilizers, must be identified.
Why this study matters
Longevity is decreased in patients with bipolar disorder by nearly 20 years, and the longevity gap between patients with bipolar disorder (and other psychiatric disorders) and the general population is on the rise.
As shown in the current study, use of mood stabilizers by patients with bipolar disorder resulted in a significant reduction in all-cause mortality and suicide.
This was a nationwide cohort study. Data were obtained from the Taiwan National Health Insurance Research Database involving 25,787 patients with bipolar disorder. Standardized mortality ratios were calculated comparing deaths among bipolar patients and the general population.
Results and conclusion
The standardized mortality ratios for all-cause mortality, suicide, and natural mortality were 5.26, 26.02, and 4.68, respectively.
Patients with bipolar disorder who were prescribed a mood stabilizer had decreased 5-year risks for all-cause mortality, suicide, and natural mortality (adjusted hazard ratio [aHR] = 0.58, 0.60, and 0.55, respectively).
Among the mood stabilizers prescribed, lithium was associated with the greatest risk reduction for all-cause mortality, suicide, and natural mortality (aHR = 0.38, 0.39, and 0.37, respectively).
Chen P-H, Tsai S-Y, Chen P-Y, et al. Mood stabilizers and risk of all-cause, natural, and suicide mortality in bipolar disorder: A nationwide cohort study. Acta Psychiatrica Scandinavica 2022; doi.org/10.1111/acps.13519.