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People with bipolar disorder who take Depakote have three times the risk of attempting suicide as those who take lithium, according to a study of 20,638 patients. Depakote is the most commonly prescribed mood stabilizer in the US. Bipolar disorder is the medical term for manic-depression.

Public health awareness during the past decade has focused on problems related to alcohol and drug abuse, as well as on mental disorders (ADM). The comorbidity (occurrence of more than one disorder in the same person) of ADM was investigated by analyzing data from the Epidemiologic Catchment Area (ECA) study, carried out by the National Institute of Mental Health (NIMH). The ECA study gathered data regarding the prevalence of ADM in structured interviews, using a standardized questionnaire; the format was such that all three disorders could be evaluated in the same interview. Information was elicited from 20,291 subjects over the age of 18. One-month, six-month, and lifetime prevalence rates of ADM per 100 persons were calculated. The rates for the lifetime occurrences of mental disorder, alcohol abuse/dependence or drug abuse/dependence were 22.5, 13.5, and 6.1 percent, respectively. Slightly more than 22 percent of people who had received a diagnosis of a mental disorder in their lifetimes had a history of alcohol abuse; 15 percent had a history of other drug abuse; and 29 percent had a history of either addictive disorder. Of those with alcohol disorders, 37 percent had one or more other mental disorder and 22 percent had another drug abuse disorder. Over half of those with a lifetime history of drug abuse also had a mental disorder; half also had a history of alcohol abuse. Comorbidity figures for specific diagnostic categories of mental disorder and drug and alcohol abuse are presented, as are figures for specific substance abuse disorders. The results show that care of mental disorders should be a primary goal of any efforts to prevent substance abuse. The reasons these comorbidity rates are so high remain a mystery. (Consumer Summary produced by Reliance Medical Information, Inc.)

Accelerating activity in research pertinent to the understanding, treatment, and prevention of alcohol-related disorders makes it inevitable that the field increasingly will find itself targeted by the animal rights movement. […]

Abstract Objective To assess the scientific and ethical basis for clinical innovation in psychopharmacology. Methods We conducted a literature review, utilizing MEDLINE search and bibliographic cross-referencing, and historical evidence regarding the discovery and development of new medications in psychiatry. Clinical innovation was defined as use of treatments in a clinical setting which have not been well-proven in a research setting. Results Empirical data regarding the impact of clinical innovation in psychopharmacology are lacking. A conceptual and historical assessment of this topic highlights the ethical and scientific importance of clinical innovation. Ethically, it touches a borderline that, in our judgment, is not adequately framed in contemporary mainstream bioethics. Currently, research is viewed as not at all benefiting the patients who participate in it, while clinical care is viewed as being solely for the benefit of patients. Clinical innovation straddles these two worlds, uncomfortably at times. While many argue that clinical innovation should either be avoided or folded into research projects, we argue that clinical innovation is necessary for progress in psychopharmacology research, and that it can prosper best when guided by the following ethical principles: 1.) The treatment should be based on a viable hypothesis. 2.) Whenever possible, one's clinical observations should be reported so they can be evaluated by the scientific community. 3.) One should be willing to report unexpected observations of drug effects. 4.) A high standard of informed consent should be maintained. Again, this proposal goes against the standard view among bioethicists that research and clinical care are categorically opposed activities, as made clear by the either-or dichotomy of the Belmont Report on bioethics. This approach has so polarized our profession into clinicians versus researchers, that many clinicians will not apply new knowledge produced by clinical research until it eventually gets incorporated into formal treatment guidelines, while researchers have little to guide them as to what kind of new knowledge it is most important to provide. Summary Clinical innovation brings out the ambiguities in our current ethical conceptions of research versus clinical care. Yet, historically, clinical innovation has been an important contributor to progress in psychopharmacology. We argue that clinical innovation should not be discouraged, but rather it should occur under certain ethical conditions. "Almost everyone can and should do research...because almost everyone has a unique observational opportunity at some time in his life which he has an obligation to record....If one considers the fundamental operations or methods of research, one immediately realizes that most people do research at some time or another, except that they do not call their activity by that name. There are seven operations....In simple language they are counting, sorting, measuring, comparing, nature-study, guess testing, and reappraisal....Guess testing is of course what most people think of when the word research is mentioned; except that it is bad manners to call a guess a guess. It should be called an hypothesis. Let us make one plea. Guessing becomes merely a game unless it is done in the context of a plan for action. It is a waste of time elaborating untestable hypotheses 1." John Cade

The central nervous system transmitter serontonin may be altered in aggressive/impulsive and suicidal behaviors in humans. These reports are largely consistent with animal data, and constitute one of the most highly replicated set of findings in biological psychiatry. Suggests that some suicidal behavior may be a special kind of aggressive behavior in humans. (Author/ABB)