Abstract
Abstract Background Bipolar disorder (BD) is associated with a high incidence of intentional self-harm and suicide attempts (SH/SA), however the effectiveness of mood-stabilizers on SH/SA remains controversial. We aimed to evaluate the real-world effectiveness of mood-stabilizers (lithium, lamotrigine, valproate, olanzapine, risperidone, aripiprazole, clozapine, and quetiapine) on SH/SA in patients with BD. Methods A two-year mirror-image design (traditional and reverse) was applied using data from nationwide Danish healthcare registers. Results In the traditional mirror-image design, treatment initiation with valproate was associated with a decreased SH/SA-incidence in all patients with BD (from 18 to 11 events/1000 person years (PYs), P = .03). In treatment-naive patients with BD, lithium initiation was associated with a decreased SH/SA-incidence (from 12 to 7 incidents per 1000 PYs, P Limitations Time-variant confounders may influence the results and may yield false positive (mimicking either a harmful or a protective effect) or false negative findings (no effect). Conclusion The present findings suggest that lithium and valproate may protect against self-harm and suicide attempts in bipolar disorder.
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