Stahl's Essential Psychopharmacology

Neuroscientific basis and practical applications

Stephen M Stahl, fourth edition, Cambridge University Press
Chapter 8. Mood stabilizers pag 372
Lithium is well established to help prevent suicide in patients with mood disorders.
Anticonvulsants including valproate have been controversially and not completely convinsingly
linked to causing suicidality, whereas lithium actually reduces suicide in patients with bipolar
disorder. In fact, some provocative studies from Austria to Texas to Japan suggest that the more
lithiym mobilized by rain from roks and soil and then dissolved in drinking water, the lower the
suicide rate in the general population as well!

Antidepressants: do they make you bipolar pag382

It seems that antidepressants either do not work , or may worsen the situation for some patients
who have bipolar disorder, causing destabilization of mood with induction if mania, rapid cycling
or mixed states or even suicidality. Young patients who present with unipolar depressive
symptoms before they express any manic or hipomanic symptoms may be particularily
vulnerable to misdiagnosis and to antidepressant-induced activation and suicidality.

Children, bipolar disorder, and mood stabilizers pag 386

Controversies in the treatment of unipolar depression in children and adolescents, such as
increasing suicidality with antidepressants, are mentioned in chapters 6 and 7.

Mixed mania affecting 20-30% of adults with bipolar mania, may often have its onset in
childhood or adolescence with the additional characteristics of chronic course, high rate of
suicide, poor response to treatment, and early history of cognitive symptoms highly suggestive
of ADHD.