Excess cardiovascular and suicide mortality of affective disorders may be reduced by lithium prophylaxis

Lithium Reduces Pathological Aggression and Suicidality: A Mini-Review

“…Several studies on the mortality of affective disorders during lithium long-term treatment by Coppen et al [23] and by the International Group for the Study of LithiumTreated Patients (IGSLI) [14,24] demonstrated that the SMR of patients with affective disorders during adequate lithium medication is normalized down to the level of the general population 1 . Coppen [25] reviewed the studies existing in the mid-nineties on the suicide rates in patients on versus off lithium and concluded that adequate lithium medication reduces the suicide-related mortality by 82%.…”

“…According to Harris and Barraclough [13] , the suiciderelated standardized mortality rate (SMR) [14] is 21.24 in major depression and 11.73 in bipolar disorder, with, however, large confidence intervals. Although some studies found a somewhat lower suicide rate in bipolar as compared to unipolar patients [15,16] , others found higher rates in bipolar patients [17][18][19] , particularly in bipolar II patients.…”

Targeting suicide prevention to modifiable risk factors: has bipolar II been overlooked?

“…Although lithium appears to have made a major impact in reducing suicide rates in bipolar and possibly related recurring unipolar patients in bipolar clinics (35,36), other mood stabilizers, such as valproate and lamotrigine, need to be further investigated in this regard. Valproate could be relevant (37), in light of the fact that mixed states are increasingly being implicated in suicidality as shown, among others (38,39), by a previous contribution of Tondo et al (40).…”

Bipolar Disorder and Suicide

“…Acute, serious negative life events can precipitate suicide behaviour in depressed patients especially, who are particularly vulnerable for suicide behaviour. Evidence of long-term effectiveness of treatments against mortality risks in BD is limited, with the notable exception of lithium prophylaxis, which clearly reduces risk of death from suicide and may also limit risk of death from natural causes / Ahrens et al, 1995;Cipriani et al, 2005/. As for suicide prevention, the main target should not only be persons who are acutely suicidal, but all depressive (and other psychiatric) patients.…”