Lithium is an effective mood stabilizer and has been shown to decrease suicidal behavior in patients with mood disorders.2 Therefore, it should be the first choice in this case if no contraindications exist. Valproic acid, quetiapine, and carbamazepine are effective mood stabilizers but have not been shown to decrease suicidal behavior and are less effective than lithium for the depressed phase of bipolar disorder. Antidepressants, such as fluoxetine, are not recommended as monotherapy for bipolar depression because of the risk of mania induction.
2. Cipriani A, Pretty H, Hawton K, Geddes JR. Lithium in the prevention of suicidal behavior and all-cause mortality in patients with mood disorders: a systematic review of randomized trials. Am J Psychiatry 2005;162:1805-19.
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