Self-harm, unintentional injury in bipolar disorder for patients on lithium, other drugs

Taking lithium was associated with reduced rates of self-harm and unintentional injury in patients with bipolar disorder compared with other commonly prescribed maintenance treatments, according to an article published online by JAMA Psychiatry.

Self-harm is a major cause of illness and injury in bipolar disorder (BPD). Risk of unintentional injury has been understudied in BPD. There is evolving evidence that lithium may reduce suicidal behavior and there have been concerns that the use of anticonvulsants may increase self-harm. There is limited information about the effects of antipsychotics when used as mood stabilizer treatment.

Joseph F. Hayes, M.Sc., M.B.Ch.B., of University College London, England, and coauthors compared rates of self-harm, unintentional injury and suicide deaths in patients prescribed lithium, valproate sodium, olanzapine or quetiapine using a large database of electronic health records in the United Kingdom.

The study of 6,671 individuals found lower rates of self-harm and unintentional injuries among those patients taking lithium compared with those prescribed valproate, olanzapine or quetiapine. The number of suicides was too low to show differences by individual drugs.

"Patients taking lithium had reduced self-harm and unintentional injury rates. This finding augments limited trial and smaller observational study results. It supports the hypothesis that lithium use reduces impulsive aggression in addition to stabilizing mood," the study concludes.