Thursday, June 17, 2010

Lithium and Suicide


An article in the British Journal of Psychiatry examined the relationship between lithium levels in drinking water and risk of suicide. The analysis was done by a team in Japan.

“We found that lithium levels were significantly and negatively associated with SMR [standardised mortality ratio] averages for 2002–2006. These findings suggest that even very low levels of lithium in drinking water may play a role in reducing suicide risk within the general population.”
And UBC’s very own Dr. Allan Young had some words to say on the matter, particularly on the possible future debate of whether or not lithium should be added to drinking water:
http://bjp.rcpsych.org/cgi/content/full/194/5/466
“It would be most unfortunate if these findings became little more than a factual curiosity, of the sort that bright students sometimes use to highlight the limitations of a professor’s wisdom… It would be surprising if lithium in drinking water were not to raise a…panoply of questions… Following up on these findings will not be straightforward or inexpensive, but the eventual benefits for community mental health may be considerable.”

The following studies provide support for decreased suicidality with lithium treatment. However, all of these studies are done by the same group of authors, more or less. As well, there are some conflicts of interest between the authors and companies producing pharmaceuticals, including lithium.

2003
The findings indicate major reductions of suicidal risks (attempts > suicides) with lithium maintenance therapy in unipolar >/= bipolar II >/= bipolar I disorder, to overall levels close to general population rates. These major benefits in syndromes mainly involving depression encourage evaluation of other treatments aimed at reducing mortality in the depressive and mixed phases of bipolar disorder and in unipolar major depression.
http://www.ncbi.nlm.nih.gov/pubmed/12720484?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_Discovery_RA&linkpos=1&log$=relatedreviews&logdbfrom=pubmed

2001
Results from 33 studies (1970-2000) yielded 13-fold lower rates of suicide and reported attempts during long-term lithium treatment than without it or after it was discontinued. Although greatly reduced, these rates remain above those estimated for the general population. Evidence for substantial, if incomplete, protection against suicide with lithium is supported by more compelling evidence than that for any other treatment provided for patients with mood disorders. Studies of commonly used, but incompletely evaluated, alternative treatments are required, and further protection against premature mortality can be anticipated with better protection against bipolar depression.
http://www.ncbi.nlm.nih.gov/pubmed/11411189?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_TitleSearch&linkpos=3&log$=pmtitlesearch4

2001
There is no definitive evidence from this review as to whether or not lithium has an anti-suicidal effect.
http://www.ncbi.nlm.nih.gov/pubmed/11687035?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_Discovery_RA&linkpos=2&log$=relatedreviews&logdbfrom=pubmed

2000
Protection against suicide with lithium is incomplete, but rates of suicides plus attempts during lithium treatment may approach general population base rates.
http://www.ncbi.nlm.nih.gov/pubmed/10826667?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_Discovery_RA&linkpos=5&log$=relatedreviews&logdbfrom=pubmed

2003
The findings indicate major reductions of suicidal risks (attempts > suicides) with lithium maintenance therapy in unipolar >/= bipolar II >/= bipolar I disorder, to overall levels close to general population rates.
http://www.ncbi.nlm.nih.gov/pubmed/12720484?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_Discovery_RA&linkpos=3&log$=relatedreviews&logdbfrom=pubmed

2006
Risks of completed and attempted suicide were consistently lower, by approximately 80%, during treatment of bipolar and other major affective disorder patients with lithium for an average of 18 months. These benefits were sustained in randomized as well as open clinical trials.
http://www.ncbi.nlm.nih.gov/pubmed/17042835?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_Discovery_RA&linkpos=1&log$=relatedarticles&logdbfrom=pubmed

2006
The findings support growing evidence of lower risk of suicidal acts during closely monitored and highly adherent, long-term treatment with lithium and indicate that treatment adherence is a potentially modifiable factor contributing to antisuicidal benefits.
http://www.ncbi.nlm.nih.gov/pubmed/17042834?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_Discovery_RA&linkpos=4&log$=relatedarticles&logdbfrom=pubmed

Studies done by some different people:

1995
In view of the fact that a placebo-controlled mortality study under long-term conditions is neither ethically nor practically feasable, our findings cannot prove definitively that long-term lithium treatment counteracts factors responsible for the excess suicide and cardiovascular mortality of affective disorders. However, our observations are compatible with such a notion.
http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6T2X-3YMWF86-K&_user=1022551&_rdoc=1&_fmt=&_orig=search&_sort=d&_docanchor=&view=c&_searchStrId=1040649680&_rerunOrigin=scholar.google&_acct=C000050484&_version=1&_urlVersion=0&_userid=1022551&md5=bac5a02c883fd9a0fa77156c63c7e3e5

1999
The findings suggest that ongoing lithium treatment is associated with a lower suicide risk. Whether this is due to lithium's mood-stabilizing properties, to lower suicide risk per se in the patients who remain in treatment, or to a specific antisuicidal effect of the lithium ion cannot be determined since patients were not randomized to discontinue treatment. This methodological shortcoming is shared with every study in the field. All results regarding the influence of lithium on suicide rates must therefore be interpreted with extreme caution.
http://cat.inist.fr/?aModele=afficheN&cpsidt=1816513

2001
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.
http://cat.inist.fr/?aModele=afficheN&cpsidt=1069492

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