Anticonvulsant therapy and
suicide risk in affective disorders

Goodwin FK
Center on Neuroscience,
Medical Progress & Society and
the Department of Psychiatry,
George Washington University Medical Center,
Washington, DC 20037, USA.
J Clin Psychiatry 1999; 60 Suppl 2:89-93; discussion 111-6


Patients with major affective disorders are more likely to complete suicide than patients in any other medical group. Established risk factors for completed suicide in affective disorders include acute depression (with turmoil, hopelessness, global insomnia, anhedonia, anxiety and/or panic), mixed episodes, rapid cycling, substance abuse, aggression and/or impulsivity, low serotonergic activity, and hypothalamic-pituitary-adrenal axis activation. Although anticonvulsants have mood-stabilizing and antidepressant properties, few data are available on the antisuicide effects of anticonvulsant treatment in manic-depressive patients. On the other hand, as reviewed elsewhere in this issue, massive data have been accumulated on the antisuicide effect of lithium. This article discusses lithium versus anticonvulsants in the prevention of suicide associated with affective disorders and future treatment strategies to reduce this most serious complication of manic-depressive illness.
Sodium valproate
Drugs and Reward
Essential fatty acids
Evolution and emotion
PTSD and bereavement
Epilepsy and depression
How stress triggers depression
Suicide, serotonin and the HPA Axis
Anticonvulsants as antidepressants for bipolars