Mood Stabilizers Associated With Increased Risk for Stroke in Bipolar Disorder

stroke art
stroke art
Exposure to carbamazepine was associated with the highest risk for stroke, particularly ischemic stroke.

The use of mood stabilizers may be associated with an increased stroke risk in patients with bipolar disorder, according to study results published in The British Journal of Psychiatry.

Researchers retrospectively analyzed data from a cohort (n=19,433) of patients with bipolar disorder using the Taiwan National Health Insurance Research Database. In the cohort, 609 cases of stroke were recognized between 1999 and 2012.  To examine the association between acute exposure to mood stabilizers and stroke onset, the investigators used a 14-day case-crossover study design. Over 14 days, potential factors were compared in patients and controls to link specific mood stabilizers with different forms of stroke, including hemorrhagic, ischemic, and others.

After regression analysis, investigators found that mood stabilizers were collectively associated with a significantly increased risk for stroke in participants with bipolar disorder (adjusted risk ratio (aRR), 1.26; 95% CI, 1.01-1.58; P =.041). With respect to specific agents, exposure to carbamazepine was associated with the highest risk for stroke (aRR, 1.68; 95% CI, 1.09-2.59; P =.018), particularly ischemic stroke. Furthermore, they reported that exposure to valproic acid was associated with an increased risk for hemorrhagic stroke (aRR, 1.76; 95% CI, 1.09-2.87; P =.022).

Lamotrigine and lithium exposure were not associated with an increased risk for stroke.

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“These findings may offer a guide for the choice of mood stabilizers in patients with bipolar disorder who require acute therapy for affective symptoms and who already have the risk factors for stroke,” the researchers wrote.

Further studies are needed to fully investigate the links between mood stabilizers and stroke.


Chen PH, Tsai SY, Pan CH, et al. Mood stabilisers and risk of stroke in bipolar disorder [published online October 8, 2018]. Br J Psychiatry. doi:10.1192/bjp.2018.203

This article originally appeared on Psychiatry Advisor