Lithium Remains Extremely Effective in Preventing Suicide, Study Finds - Everyday Health

By Jeffrey Kopman, Everyday Health Staff Writer

THURSDAY, June 27, 2013 — People living with a mood disorder face a 30 times greater risk of suicide than the general population, but scientists hope that lithium can reduce that risk by more than 60 percent, according to a study from the University of Oxford published in the British Medical Journal.
Lithium is a commonly used medication for psychiatric disorders, specifically bipolar disorder and depression.  Previous studies found that lithium might play a role in reducing suicide rates associated with these conditions, but larger samples were recommended for future studies.
The University of Oxford study examined 48 trials from 1968 to 2013 involving 6,674 participants. The study was 70 percent larger than any previous studies to examine the benefits of lithium.
In addition to lithium, trial participants were tested on the effects of several other drugs relative to a placebo. These drugs included: amitriptyline, carbamazepine, valproate (including divalproex), fluoxetine, fluvoxamine, imipramine, lamotrigine, mianserin, maprotiline, nortriptyline, olanzapine, phenelzine, quetiapine, and thyroid hormone.
When compared with a placebo, lithium treatment resulted in fewer suicides and fewer deaths from any other cause. Lithium also showed some benefit for preventing cases of self-harm, although the correlation was not as strong.
“Lithium has been used for suicide prevention for 30 years,” said Edward Shorter, PhD FRSC, professor of psychiatry at University of Toronto, who was not affiliated with the study. “All studies, except for one in 2005, have shown that it can prevent suicide. Lithium, if taken regularly, can keep you illness free. Preventing suicide is important, but it’s not the only benefit of lithium.”
However, the updated analysis further confirms that lithium is one of the most effective treatment options for suicide prevention, and clearly showed a reduced risk of suicide and death of more than 60 percent compared to a placebo.
While the benefits of lithium versus other active drugs were not considered to be statistically significant, study authors did note that lithium performed better than carbamazepine in reducing episodes of self-harm.
Researchers attributed the reduced suicide risk to lithium’s ability to reduce mood disorder relapses, and suggested the drug might also decrease aggression and impulsivity.
“This updated systematic review reinforces lithium as an effective agent to reduce the risk of suicide in people with mood disorders," said the study authors. "Understanding the mechanism by which lithium acts to decrease suicidal behavior could lead to a better understanding of the neurobiology of suicide."
Despite adverse effects, lithium therapy should be considered as part of the clinical decision making process that weighs the pros and cons of treatment, the study concluded.
Some patients might not want to take on the added side effects associated with lithium treatment, which include nausea, headache, tremor of hands, dehydration, and lithium toxicity through overdose.
“The benefits of lithium are considerable, and the adverse effects only affect a small minority,” said Dr. Shorter. “They can include loss of renal function, but this is uncommon. Many patients stay on lithium for decades without any side effects.”
Alternative options include other mood stabilizing drugs, and electroconvulsive therapy.
“Mood stabilizers also have some effect in suicide prevention, and some don’t have the side effects of lithium,” explained Shorter. “But the main alternative is electroconvulsive therapy (ECT), which is super effective to prevent suicide, and has unjustly received negative reputation.”
ECT, commonly known as electroshock therapy, induces seizures in patients to treat psychiatric disorders. First used in 1938, ECT remains one of the more controversial and heavily opposed treatment options, due to the graphic nature of the treatment. The therapy requires patients to be placed under general anesthesia and muscle relaxers before receiving electric pulses to the head.
Side effects can include severe short-term memory loss, causing the FDA to claim it is a high risk option — an opinion Dr. Shorter and the American Psychiatric Association disagree with.
“I would recommend ECT over lithium. If your patient is suicidal, ECT is the best treatment," concluded Shorter.

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