Lithium Treatment Reduces Suicide Risk in Recurrent Major Depressive Disorder

Department of Psychiatry, Harvard Medical School, Boston, MA, USA.
The Journal of Clinical Psychiatry (Impact Factor: 5.5). 04/2007; 68(3):380-3. DOI: 10.4088/JCP.v68n0304
Source: PubMed


Evidence that clinical treatment reduces suicide risk in major depressive disorder (MDD) is limited and inconsistent. Since lithium shows major antisuicidal effects in bipolar disorders and in heterogeneous mood disorder samples, we evaluated evidence of antisuicidal effects of lithium in patients with recurrent MDD.
We searched MEDLINE (January 1966 to April 2006; search terms: lithium, suicide, affective disorder, depression, major depression, and mood disorder) for studies reporting suicides or suicide attempts during treatment with and without lithium in recurrent MDD patients, and we added data for 78 new subjects, provided from the Lucio Bini Mood Disorders Research Center in Sardinia, Italy. Suicide rates were pooled and analyzed by use of incidence-rate ratios (IRRs) and meta-analytic methods.
Eight studies involved 329 MDD patients and exposure for 4.56 years (1149 person-years) with, and 6.27 years (1285 person-years) without, lithium. Overall risk of suicides and suicide attempts was 88.5% lower with vs. without lithium: 0.17%/y versus 1.48%/y (IRR = 8.71; 95% CI: 2.10 to 77.2, p = .0005); for completed suicides (85% risk reduction), IRR = 6.77 (95% CI: 1.29 to 66.8, p = .01). Meta-analysis by risk difference and risk ratio supported these findings, and sensitivity analysis yielded similar results with studies omitted serially.
This is the first meta-analysis suggesting antisuicidal effects of lithium in recurrent MDD, similar in magnitude to that found in bipolar disorders.

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    • "Baldessarini et al. (2006) conducted a meta-analysis of 45 studies including more than 33,000 patients showing that patients treated with lithium had a 5-fold reduced risk of suicide or suicide attempts compared to patients treated with other substances. When analyzing data of 328 Sardinian patients with unipolar depression, Guzzetta et al. (2007) found a significant lower risk for suicide attempts and suicides in lithium-treated patients. "
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    ABSTRACT: The management and treatment of patients with suicidal behavior is one of the most challenging tasks for health-care professionals. Patients with affective disorders are at high risk for suicidal behavior, therefore, should be a target for prevention. Numerous international studies of lithium use have documented anti-suicidal effects since the 1970s. Despite the unambiguous evidence of lithium's anti-suicidal effects and recommendations in national and international guidelines for its use in acute and maintenance therapy of affective disorders, the use of lithium is still underrepresented. The following article provides a comprehensive review of studies investigating the anti-suicidal effect of lithium in patients with affective disorders.
    12/2015; 3(1):32. DOI:10.1186/s40345-015-0032-2
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    • "Although over 60 years have elapsed since its effects on mania were first described, lithium (LI) is still a mainstay in the treatment of mood disorders and remains the standard against which new mood-stabilizing or thymoleptic drugs are measured (Price and Heninger 1994). LI treatment paradoxically relieves both mania and depression—conditions that appear to be opposites, and additionally, it has been reported to have specific antisuicidal effects (Baldessarini et al. 2006; Guzzetta et al. 2007). However, the mechanism by which LI effectively treats bipolar disorder (BP) and depression and reduces the risk of suicidal behaviors is largely unknown. "
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    ABSTRACT: Both valproic acid (VPA) and lithium (LI) are well-established treatments for therapy of intense and sustained mood shifts, which are characteristics of affective disorders, such as bipolar disorder (BP). As mood and cognitive judgment bias have been found to be strongly interrelated, the present study investigated, in an animal model, whether acute treatment with VPA or LI could affect cognitive judgment bias. To accomplish this goal, two groups of rats received single injections of either VPA or LI after initial behavioral training and were subsequently tested with the ambiguous-cue interpretation (ACI) test. Both drugs were administered in three doses using the fully randomized Latin square design. VPA (100, 200, and 400 mg/kg) had no significant effect on the interpretation of the ambiguous cue. LI at the lowest dose (10 mg/kg) had no effect; at an intermediate dose (50 mg/kg), it significantly biased animals towards positive interpretation of the ambiguous cue, and at the highest dose (100 mg/kg), it impaired the ability of animals to complete the test. To our knowledge, this is the first study demonstrating lithium's effects on increased optimistic judgment bias. Future studies may focus on the ability of putative pharmacotherapies to modify the cognitive judgment bias dimension of patients at risk for bipolar disorder or depression.
    Psychopharmacology 12/2014; 232(12). DOI:10.1007/s00213-014-3847-0 · 3.88 Impact Factor
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    • "Higher levels of lithium have been associated with lower suicide rates (Schrauzer and Shrestha, 1990; Ohgami et al., 2009; Kapusta et al., 2011; Helbich et al., 2012; Blüml et al., 2013). While suicide protective properties of lithium in therapeutic dosages are well established (Baldessarini et al., 2006; Guzzetta et al., 2007), the exact mode of action of the low levels of lithium found in drinking water is still not known. Indeed, contradictory results have been reported (Kabacs et al., 2011) and the few conducted studies have been challenged due to limitations such as too simplistic statistical models, disregard of the possible influence of space as well as potential interaction effects (Huthwaite and Stanley, 2010; Yang, 2011). "

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