Mood stabilisers are the main treatment for bipolar disorder. However, it is uncertain which drugs have the best outcomes.

To investigate whether rates of suicide, self-harm and psychiatric hospital admission in individuals with bipolar disorder differ between mood stabilisers.

A cohort design was applied to people aged ≥15 years who were diagnosed with bipolar disorder and living in Denmark during 1995–2016. Treatment with lithium, valproate, other mood stabilisers and antipsychotics were compared in between- and within-individual analyses, and adjusted for sociodemographic characteristics and previous self-harm.

A total of 33 337 individuals with bipolar disorder were included (266 900 person-years). When compared with individuals not receiving treatment, those receiving lithium had a lower rate of suicide (hazard ratio 0.40, 95% CI 0.31–0.51). When comparing treatment and non-treatment periods in the same individuals, lower rates of self-harm were found for lithium (hazard ratio 0.74, 95% CI 0.61–0.91). Lower rates of psychiatric hospital admission were found for all drug categories compared with non-treatment periods in within-individual analyses (P<0.001). The low rates of self-harm and hospital admission for lithium in within-individual analyses were supported by results of between-individual analyses.

Lithium was associated with lower rates of suicide, self-harm and psychiatric hospital readmission in all analyses. With respect to suicide, lithium was superior to no treatment. Although confounding by indication cannot be excluded, lithium seems to have better outcomes in the treatment of bipolar disorder than other mood stabilisers.

情绪稳定剂是双相情感障碍的主要治疗方法。然而，尚不确定哪种药物的效果最好。

调查双相情感障碍患者的自杀率、自残率和精神病院入院率是否在情绪稳定剂之间存在差异。

队列设计适用于 1995-2016 年期间被诊断患有双相情感障碍并居住在丹麦的 15 岁以上人群。在个体间和个体间分析中比较了锂、丙戊酸盐、其他情绪稳定剂和抗精神病药物的治疗，并根据社会人口学特征和先前的自残情况进行了调整。

共纳入 33 337 名双相情感障碍患者（266 900 人年）。与未接受治疗的人相比，接受锂治疗的人自杀率较低（风险比 0.40，95% CI 0.31-0.51）。在比较同一个体的治疗期和非治疗期时，发现锂的自伤率较低（风险比 0.74，95% CI 0.61-0.91）。在个体内分析中，与非治疗期相比，所有药物类别的精神病院入院率均较低（P <0.001）。个体间分析的结果支持了个体内部分析中锂的低自伤率和住院率。

在所有分析中，锂与较低的自杀率、自残率和精神病院再入院率相关。关于自杀，锂优于不治疗。虽然不能排除因适应症引起的混淆，但锂在治疗双相情感障碍方面似乎比其他情绪稳定剂有更好的结果。