Author/Editor		Mueller-Oerlinghausen, Bruno
Title		Antisuicidal effects of lithium
Type		članek
Source		In: Grad-Tekavčič O, editor. Suicide risk and protective factors in the new millennium. Ljubljana: Cankarjev dom,
Publication year		2001
Volume		str. 85-90
Language		eng
Abstract		Affective disorders are first characterized by a high recurrence risk, second a 30-50 times increased suicide risk, third a 2-3 times increased overall mortality. In contrast to a populistic belief no scientific evidence exists that antidepressant treatment, particularly long-term treatment could reduce the risk of suicidal acts in depressive patients with a history of suicide attempts. Data, however, coming from international, systematic, retrospective analyses of well-documented long-term courses of illness in reliably diagnosed patients, and from a large national, prospective long-term trial on the prophylactic efficacy of lithium versus carbamazepine and amitriptyline has accumulated in the last 10-15 years strongly supporting (a possibly specific) antisuicidal effect of lithium. The large collaborative IGSLI-study covering 5,616 patient years clearly showed that adequate long-term lithium treatment significantly reduces and even normalizes the excess mortality of patients with affective disorders. A metaanalysis on 17,000 patients pooled from 28 studies demonstrated that the rate of suicidal acts is 8.6 fold higher in patients without lithium as compared to those with regular lithium treatment. A large multicentre, controlled long-term trial from Germany found not any suicidal acts in 146 patients randomized on lithium compared to 9 suicidal acts in 139 patients randomized on carbamazepine. Reanalysis of the data from the IGSLI-study supports the concept of the specificity of lithium, i. e. evidence could be provided that lithium reduces suicidal behaviour also in patients who do not benefit from the lithium treatment in terms of episode reduction. Conclusion: Lithium has to be considered as first line mood stabilizer in affective disorders particulary in patients with a history of suicide attempts. (Abstract truncated at 2000 characters).
Descriptors		SUICIDE LITHIUM