Subscribe to RSS
DOI: 10.1055/s-2001-15878
Does Lithium Exert an Independent Antisuicidal Effect?
Publication History
Publication Date:
31 December 2001 (online)
![](https://www.thieme-connect.de/media/pharmaco/200104/lookinside/thumbnails/10.1055-s-2001-15878-1.jpg)
Aim of study: Recent investigations have indicated that adequate lithium treatment lowers the suicide mortality associated with affective illness. One important question is whether the mechanism by which lithium prophylaxis may be effective in prolonging survival can be explained exclusively in terms of successful protection against the recurrence of depressive episodes, or whether one should consider an independent anti-suicidal factor. Methods: We investigated a group of high-risk patients with recurrent affective disorders (n = 167) who had committed one or more suicide attempts before the start of lithium prophylaxis within a collaborative project by the International Group for the Study of Lithium Treated Patients (IGSLI). According to their recurrence-related response to long-term lithium prophylaxis, patients were classified into three groups: excellent (n = 45), moderate (n = 81) and poor responders (n = 41). Only depressive episodes resulting into hospitalisation were considered. A marked reduction in the number of suicide attempts was observed in the excellent lithium responders. However, we also found that over 80 % of moderate responders and nearly 50 % of poor responders did not exhibit any further suicidal behaviour during lithium treatment. Furthermore, we could demonstrate a significant reduction of suicide attempts per year as compared to a corresponding pre-lithium period in all three groups (0.10 vs. 0.33, 0.06 vs. 0.27, 0.02 vs. 0.26). There were four suicides in this high-risk group, corresponding to a suicide-related standardised mortality ratio (SMR) of 13.7. This contrasts sharply with an expected suicide SMR of approx. 100 in this population. Suicide risk was not related to the recurrence-preventing effect. Conclusion: The reduction in suicide attempts, in both responders and non-responders, indicates that lithium possesses a specific anti-suicidal effect besides its mood-stabilising property.
References
- 1 Ahrens B, Grof P, Möller H J, Müller-Oerlinghausen B, Wolf T. Lithium treatment and survival in patients with affective disorders. Can Journal of Psychiatry. 1995a ; 40 241-246
- 2 Ahrens B, Linden M. Is there a suicidality syndrome independent of specific major psychiatric disorder? Results of a split half multiple regression analysis. Acta Psychiatrica Scandinavica. 1996; 94 79-86
- 3 Ahrens B, Müller-Oerlinghausen B, Schou M, Wolf T, Alda M, Grof E, Grof P, Lenz G, Simhandl C, Thau K, Wolf R, Möller H J. Excess cardiovascular and suicide mortality of affective disorders may be reduced by lithium-prophylaxis. Journal of Affective Diorders. 1995 b ; 33 67-75
- 4 Blair-West G W, Mellsop G W, Eyesonannan M L. Down-rating lifetime suicide risk in major depression. Acta Psychiatrica Scandinavica. 1997; 95 259-263
-
5 Breslow N E, Day N E.
The standardized mortality ratio. In Sen PN, editor Biostatistics: Statistics in Biomedical, Public Health and Environmental Sciences. Amsterdam; Elsevier 1985: 55-74 - 6 Cabrera J F, Körner W, Müller-Oerlinghausen B. Erfolgreiche kombinierte Neuroleptika-Lithium-Behandlung eines chronisch schizophrenen Kranken mit rezidivierendem aggressiven Verhalten. Nervenarzt. 1986; 57 366-369
- 7 Campbell M, Small A M, Green W H, Jennings S J, Perry R, Bennett W G, Anderson L. Behavioral efficacy of haloperidol and lithium carbonate. Archives of General Psychiatry. 1984; 41 650-656
- 8 Coppen A. Depression as a lethal disease: Prevention Strategies. Journal of Clinical Psychiatry. 1994; 55 (Suppl. 4) 37-45
- 9 Coppen A, Standish-Barry H, Bailey J, Houston G, Silcocks P, Hermon C. Does lithium reduce the mortality of recurrent mood disorders?. Journal of Affective Diorders. 1991; 23 1-7
- 10 Donovan S, Clayton A, Beeharry M, Jones S, Kirk C, Waters K, Gardner D, Faulding J, Madeley R. Deliberate self-harm and antidepressant drugs. British Journal of Psychiatry. 2000; 177 551-556
- 11 Fava M, Rosenbaum J F, Pava J A, McCarthy M K, Steingard R J, Bouffides E. Anger Attacks in Unipolar Depression, Part 1: Clinical Correlates and Response to Fluoxetine Treatment. American Journal of Psychiatry. 1993; 150 (8) 1158-1163
- 12 Greil W, Ludwig-Mayrhofer W, Erazo N, Engel R R, Czernik A, Giedke H, Müller-Oerlinghausen B, Osterheider M, Rudolf G AE, Sauer H, Tegeler J, Wetterling T. Lithium vs carbamazepine in the maintenance treatment of schizoaffective disorder: a randomized study. European Archives of Psychiatry and Clinical Neuroscience. 1997 a ; 247 42-50
- 13 Greil W, Ludwig-Mayrhofer W, Erazo N, Schöchlin C, Schmidt S, Engel R R, Czernik A, Giedke H, Müller-Oerlinghausen B, Osterheider M, Rudolf G AE, Sauer H, Tegeler J, Wetterling T. Lithium vs. carbamazepine in the maintenance treatment of bipolar disorders: a randomized study. Journal of Affective Disorders. 1997 b ; 43 151-161
- 14 Guze S B, Robins E. Suicide and primary affective disorders. British Journal of Psychiatry. 1970; 117 437-438
- 15 Johnson F N. The psychopharmacology of lithium. London; Macmillan Press, 1984
- 16 Motto J. Suicide attempts: a longitudinal view. Archives of General Psychiatry. 1965; 13 516-520
- 17 Müller-Oerlinghausen B. Lithium long-term treatment: Does it act via serotonin?. Pharmacopsychiatry. 1985; 18 214-217
- 18 Müller-Oerlinghausen B, Ahrens B, Grof E, Grof P, Lenz G, Schou M, Simhandl C, Thau K, Volk J, Wolf R, Wolf T. The effect of long-term lithium treatment on the mortality of patients with manic-depressive and schizoaffective illness. Acta Psychiatrica. Scandinavica 1992 a ; 86 218-222
- 19 Müller-Oerlinghausen B, Müser-Causemann B, Volk J. Suicides and parasuicides in a high-risk patient group on and off lithium long-term medication. Journal of Affective Diorders. 1992 b; 25 261-270
- 20 Müller-Oerlinghausen B, Wolf T, Ahrens B, Glaenz T, Schou M, Grof E, Grof P, Lenz G, Simhandl C, Thau K, Vestergaard P, Wolf R. Mortality of patients who dropped out from regular lithium prophylaxis: a collaborative study by the International Group for the Study of Lithium-Treated patients (IGSLI). Acta Psychiatrica Scandinavica. 1996; 94 344-347
- 21 Nilsson A. Mortality in recurrent mood disorders during periods on and off lithium. A complete population study in 362 patients. Pharmacopsychiatry. 1995; 28 8-13
- 22 Olivier B, Mos J, Heyden van der J, Hartog J. Serotonergic modulation of social interactions in isolated male mice. Psychopharmacology. 1989; 97 154-156
- 23 Price L H, Charney D S, Delgado P L, Heininger G R. Lithium and serotonin function: implication for the serotonin hypothesis of depression. Psychopharmacology. 1990; 100 3-12
- 24 Schou M. The effect of prophylactic lithium treatment on mortality and suicidal behavior: A review for clinicians. Journal of Affective Disorders. 1998; 50 253-259
- 25 Sheard M H. Effect of lithium on human aggression. Nature. 1971; 230 113-114
- 26 Sheard M H. Clinical pharmacology of aggressive behavior: review. Clinical Neuropharmacology. 1984; 7 173
- 27 Sheard M H, Marini J L, Bridges C I, Wagner E. The effect of lithium on impulsive aggressive behavior in man. American Journal of Psychiatry. 1976; 133 1409-1413
- 28 Tariot P N, Erb R, Podgorski C A, Cox C, Patel S, Jakimovich L, Irvine C. Efficacy and tolerability of carbamazepine for agitation and aggression in dementia. American Journal of Psychiatry. 1998; 155 54-61
- 29 Thies-Flechtner K, Müller-Oerlinghausen B, Seibert W, Walther A, Greil W. Effect of prophylactic treatment on suicide risk in patients with major affective disorders. Data from a randomized trial. Pharmacopsychiatry. 1996; 29 103-107
-
30 Tondo L, Baldessarini R J, Floris G, Silvetti F, Rudas N.
Lithium maintenance treatment reduces risk of suicidal behavior in bipolar disorder patients. In: Gallicchio VS, Birch NJ, editors Lithium: Biochemical and Clinical Advances. Connecticut; Weidner 1996: 161-171 - 31 Tuckman J, Youngman W. Identifying suicide with groups among attempted suicide. Public Health Pre. 1963; 78 763-766
- 32 Valzelli L, Garattini S. Biochemical and behavioural changes induced by isolation in rats. Neuropharmacology. 1972; 11 17
- 33 van Praag H M, Plutchik R, Apter A. editors Violence and Suicidality. Perspectives in Clinical and Psychobiological Research. New York; Brunner/Mazel 1990
- 34 Verkes R J, Mast van der R C, Hengeveld M W, Tuyl J P, Zwindermann A H, van Kempen G MJ. Reduction by paroxetine of suicidal behavior in patients with repeated suicide attempts but not major depression. American Journal of Psychiatry. 1998; 155 (4) 543-547
- 35 Wickham E A, Reed J V. Lithium for the control of aggressive and self-mutilating behaviour. International Journal of Clinical Psychopharmacology. 1987; 2 181-190
PD Dr. B. Ahrens
Department of Psychiatry
University of Lübeck
Ratzeburger Allee 160
23538 Lübeck
Germany
Email: bernd.ahrens@medinfo.mu-luebeck.de