Bipolar, Psych Meds and Suicidality: Which Meds Work?

I continue to be amazed at the lack of effectiveness of some psych meds in achieving their main goals, one of which is suicide prevention. Here's a new bit of evidence (abstract-only) from a major NIMH-funded study of bipolar disorder. I'll just quote from the abstract:

"The presence of suicidal ideation was similar between patients who were taking any lithium and those who were not (22.2 percent and 25.8 percent, respectively) and between those who were taking any divalproex and those who were not (20.3 percent and 21.5 percent). Suicidal ideation was significantly more prevalent among patients who were taking a second-generation antipsychotic than those who were not (26 percent and 17 percent) and those who were taking an antidepressant and those who were not (25 percent and 14 percent)."

What jumps out at me is the authors' claim that Lithium is most-commonly used in patients with the severest ideation problems (a little-advertised fact is that studies establish that good old Lithium has many suicide preventing qualities, and outperforms antidepressants) and that atypical antipsychotics and anti-depressants don't work better than Lithium and Depakote (divalproex) at preventing suicidality in bipolar disorder. So why do so many doctors insist on slapping bipolars with atypicals, when there are huge side effects problems with the very expensive drugs and there is plenty of emerging evidence that they don't work well (cf. CATIE study)? You can ask the same question about anti-depressants as well. When is the psych world going to burst into honesty about these meds, which are taken by millions of Americans each year?

What also jumps out at me is that one of this study's principal authors is Joseph Calabrese. In recent weeks, Calabrese has been quoted in several press accounts about just how wonderful Seroquel (America' most-prescribed atypical!) is at preventing suicide and suicidality. Here's a typical example. But the above study was released in December, roughly the same time as he was touting Seroquel. I won't even guess at the reasons for this inconsistency.

Calabrese is also one of the leading advocates for Seroquel's use as the new mood stabilizer. I am not impressed.