The edition · Psychiatry
Lithium and valproate came out level on suicide risk
A territory-wide cohort and network meta-analysis found no separation between the two mood stabilisers, while both beat no treatment. Plus a decade of falling benzodiazepine dispensing, a buprenorphine label mix-up recall, and plasma proteomics that track symptoms rather than diagnosis.
The edition in brief
A Hong Kong cohort of 1,379 lithium and 5,556 valproate monotherapy initiators with bipolar disorder found no significant difference in suicide risk (weighted HR 0.76, 95% CI 0.54-1.08). A pairwise meta-analysis of eight observational studies agreed (pooled HR 0.87, 0.69-1.09). In network meta-analysis both agents were associated with lower suicide risk than no treatment — lithium HR 0.46 (0.33-0.64), valproate 0.63 (0.45-0.88) — with no separation between them (0.73, 0.52-1.02). Randomised trials could not be pooled. United States benzodiazepine dispensing fell 26.7% between 2013 and 2024, from a 7.5% to a 5.5% annual population prevalence, across 1.1 billion prescription fills. The steepest fall was among adults aged 18 to 29 (-44.8%). By prescriber, pain medicine fell 62.5%, primary care 44.3% and psychiatry 38.3%, while advanced practice providers rose 101.5%. Mean total dose per prescription fell across every age and prescriber group. The FDA lists an ongoing Class III recall of 2 mg buprenorphine sublingual tablets packaged by American Health Packaging, for a label mix-up. Class III means unlikely to cause adverse health consequences. Plasma proteomic profiling of 7,289 analytes in 1,881 Dutch participants found only seven proteins separating current major depressive disorder from controls, but 57 associated with atypical symptoms and none reaching significance for melancholic symptoms. Danish registry data on 549,541 parental couples found substantial partner similarity for psychiatric diagnoses (r = 0.28 overall, 0.38 for schizophrenia), inflating family-based heritability estimates by 12.5%.
Benzodiazepine dispensing fell by a quarter, but not everywhere
Benzodiazepine dispensing in the United States fell by about a quarter over a decade with smaller doses per prescription; use it as a benchmark for reviewing your own service's prescribing.
Class III recall of 2 mg buprenorphine sublingual tablets for a label mix-up
An ongoing Class III FDA recall covers 2 mg buprenorphine sublingual tablets from one American packager for a label mix-up; verify institutional stock and protect dose continuity.
Plasma proteins tracked depressive symptoms better than the diagnosis
Symptom dimensions, not the categorical diagnosis, carried the proteomic signal — worth documenting a patient's symptom profile, but nothing here is orderable.
Partners resemble each other diagnostically, and it inflates heritability estimates
Ask about both parents when taking a family history — partner similarity for psychiatric diagnosis is substantial and concentrates risk in the children of such couples.
A lithium level is only interpretable if you know when the dose was taken
Record the time of the last dose on every lithium request, sample at about 12 hours, and repeat sick-day advice at each review rather than once at initiation.
Lithium and valproate came out level on suicide risk, and both beat no treatment
Choose between lithium and valproate on tolerability, comorbidity and monitoring rather than a presumed suicide-prevention advantage — but treating matters far more than which agent is chosen.
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