Adjunctive lithium treatment in the prevention of suicidal behaviour in depressive disorders: a randomised, placebo-controlled, 1-year trial.
ABSTRACT Evidence based on controlled studies is still limited for treatment strategies that prevent recurrence of suicide attempts. Findings from observational as well as meta-analytic studies strongly suggest that lithium may have suicide-protective properties.
Patients with a recent suicide attempt in the context of an affective spectrum disorder (n = 167) were treated with either lithium or placebo during a 12-month period.
Survival analysis showed no significant difference of suicidal acts between lithium and placebo-treated individuals (adjusted hazard ratio 0.517; 95% CI 0.18-1.43). However, post hoc analysis revealed that all completed suicides had occurred in the placebo group accounting for a significant difference in incidence rates (P = 0.049).
Results indicate that lithium treatment might be effective in reducing the risk of completed suicide in adult patients with affective disorders. Our findings contribute to the growing body of evidence suggesting a specific antisuicidal effect of lithium.
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ABSTRACT: The long-term suicide risk of depression was evaluated in a community sample by severity and gender. The Lundby study is a prospective, longitudinal cohort study on a population consisting of 3563 subjects. In 1947-1997 medium or severe depression according to the Lundby diagnostic system were registered in 503 subjects. The same subjects were also diagnosed according to DSM-IV showing major depressive disorder (MDD) in 293 and depressive disorder not otherwise specified (DDNOS) in 131 subjects. The overall long-term suicide risk varied from 5.6% to 6.8%. The long-term suicide risk was 3.1% for medium and 11.4% for severe 'Lundby depression', 3.7% for medium and 13.8% for severe MDD + DDNOS, 3.1% for medium and 13.7% for severe MDD. Severity and male sex were risk factors for suicide. Males with a severe depression showed a high long-term risk for suicide, around 20%.Acta Psychiatrica Scandinavica 04/2008; 117(3):185-91. · 4.86 Impact Factor
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ABSTRACT: The suicide-related mortality among patients with affective disorders is approximately 30 times higher, and overall mortality 2 to 3 times higher, than suicide-related mortality in the general population. Lithium has demonstrated possibly specific antisuicidal effects apart from its prophylactic efficacy: it significantly reduces the high excess mortality of patients with affective disorders. To date, suicide-prevention effects have not been shown for antidepressant or anticonvulsant long-term treatment. Clozapine appears to reduce the suicide rate in schizophrenia patients. Against this background, guidelines and algorithms for selecting an appropriate prophylactic strategy for affective disorders should consider the presence of suicidality in patient history. Appropriate lithium prophylaxis prevents approximately 250 suicides yearly in Germany, although lithium salts are infrequently prescribed within the National Health Scheme (specifically, to 0.06% of the population). Rational treatment strategies most likely would demand that prescription rates be about 10 times higher.Canadian journal of psychiatry. Revue canadienne de psychiatrie 09/2003; 48(7):433-9. · 2.48 Impact Factor
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ABSTRACT: The authors studied 954 psychiatric patients with major affective disorders and found that nine clinical features were associated with suicide. Six of these--panic attacks, severe psychic anxiety, diminished concentration, global insomnia, moderate alcohol abuse, and severe loss of interest or pleasure (anhedonia)--were associated with suicide within 1 year, and three others--severe hopelessness, suicidal ideation, and history of previous suicide attempts--were associated with suicide occurring after 1 year. These findings draw attention to the importance of 1) standardized prospective data for studies of suicide, 2) assessment of short-term suicide risk factors, and 3) anxiety symptoms as modifiable suicide risk factors within a clinically relevant period.American Journal of Psychiatry 10/1990; 147(9):1189-94. · 14.72 Impact Factor