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Riesgo de suicidio en el trastorno bipolar durante el tratamiento con litio y divalproex
Frederick K Goodwin1, Bruce Fireman, Gregory E Simon
1Department of Psychiatry, George Washington University Medical Center, Washington, DC 20037, USA. fgoodwin@mfa.gwu.edu
JAMA
|September 18, 2003
Resumen
Los pacientes con trastorno bipolar tienen un menor riesgo de intentos de suicidio y muertes cuando son tratados con litio en comparación con divalproex. Este estudio destaca diferencias cruciales en el riesgo de suicidio entre estos estabilizadores del estado de ánimo comunes.
Área de la Ciencia:
- La psiquiatría es la psiquiatría.
- Farmacología Farmacología.
- Salud Pública La salud pública.
Sus antecedentes:
- La investigación existente sugiere que el tratamiento con litio puede reducir el riesgo de suicidio en pacientes con trastorno bipolar.
- Ningún estudio previo ha investigado el riesgo de suicidio asociado con divalproex, un estabilizador del estado de ánimo ampliamente prescrito en los Estados Unidos.
Objetivo del estudio:
- Para comparar el riesgo de intentos de suicidio y muertes por suicidio entre los tratamientos de litio y divalproex en pacientes con trastorno bipolar.
- Evaluar los perfiles de seguridad comparativos del litio frente al divalproex con respecto a las conductas suicidas.
Principales métodos:
- Se realizó un estudio de cohorte retrospectivo utilizando datos de dos grandes planes de salud integrados en California y Washington.
- Se analizó una muestra basada en la población de 20.638 miembros de planes de salud diagnosticados con trastorno bipolar y recetados con litio, divalproex o carbamazepina entre 1994 y 2001.
- Los intentos de suicidio se identificaron a través del alta hospitalaria o los diagnósticos del departamento de emergencias, y las muertes por suicidio se confirmaron a través de certificados de defunción.
Principales resultados:
- Los análisis no ajustados revelaron tasas significativamente más altas de intentos de suicidio en el departamento de emergencias, hospitalización por intentos de suicidio y muertes por suicidio durante el tratamiento con divalproex en comparación con el litio.
- Después de ajustar por factores demográficos y clínicos, el riesgo de muerte por suicidio fue 2,7 veces mayor con divalproex que con litio (95% IC, 1.1-6.3; P =.03).
- Los ratios de riesgo ajustados para los intentos de suicidio no fatales fueron de 1,8 (95% IC, 1.4-2.2; P<.001) para los diagnósticos de urgencias y de 1,7 (95% IC, 1.2-2.3; P =.002) para las hospitalizaciones.
Conclusiones:
- El tratamiento con litio se asocia con un menor riesgo de intentos de suicidio y muertes por suicidio en comparación con divalproex en pacientes diagnosticados con trastorno bipolar.
- Estos hallazgos subrayan la importancia de considerar la elección de la medicación en la gestión del riesgo de suicidio para las personas con trastorno bipolar.
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