Mood Stabilizers and Stroke Risk: New Data

Peter M. Yellowlees, MBBS, MD


March 14, 2019

This transcript has been edited for clarity.

This is the Medscape Psychiatry Minute. I'm Dr Peter Yellowlees.

Research on the risk for stroke following the use of mood stabilizers in patients with bipolar disorder is limited. Recently, a team of investigators from Taipei Medical University in Taiwan investigated the risk for stroke following exposure to mood stabilizers in a retrospective cohort of 19,433 patients with bipolar disorder, in which 609 new-onset cases of stroke were identified from 1999 to 2012.[1]

The researchers found that acute exposure to carbamazepine was associated with the highest risk for stroke, particularly ischemic stroke, and that acute exposure to valproic acid elevated the risk for hemorrhagic stroke. In contrast, acute exposure to lithium and lamotrigine did not significantly increase the risk for any type of stroke.

For clinicians, this is an important, methodologically sound study to remember when prescribing mood stabilizers, especially for patients who may be at risk for stroke from lifestyle factors such as smoking, obesity, and alcohol consumption. From a clinical-effectiveness perspective, we already know that lithium and lamotrigine should generally be our first-choice mood stabilizers in patients with bipolar disorder. This study provides further safety data supporting these prescribing choices.

Thank you for listening to this Medscape Psychiatry Minute. Do continue to enjoy your practice.

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