Lithium and suicide prevention in bipolar disorder

Bénard, V.; Vaïva, Guillaume; Masson, Marc; Geoffroy, Pierre Alexis

doi:10.1016/j.encep.2016.02.006

Cited by 44 publications

(32 citation statements)

References 66 publications

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“…‐ 38 It may also reduce the severity and frequency of episodes should relapses occur. Other maintenance treatments such as valproate or lamotrigine may be added to lithium if necessary, and lithium is generally well tolerated 37 , 39 , 40 . However, initial management is often highly involved, with a need for frequent monitoring of lithium plasma levels and adjustment of doses in order to ensure tolerability and limit the risk of toxicity 36 .…”

Section: Recommendationsmentioning

confidence: 99%

“…Other maintenance treatments such as valproate or lamotrigine may be added to lithium if necessary, and lithium is generally well tolerated. 37,39,40 However, initial management is often highly involved, with a need for frequent monitoring of lithium plasma levels and adjustment of doses in order to ensure tolerability and limit the risk of toxicity. 36 Weekly, monthly, then quarterly appointments with a doctor involving blood tests are recommended in order to monitor the efficacy and side effects 2 Stepwise management of mania* not tolerated not tolerated c ¼ combination; m ¼ monotherapy.…”

Section: Clinical Recommendations For the Long Term Management Of Bipmentioning

confidence: 99%

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Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for mood disorders: bipolar disorder summary

Malhi

Outhred

Morris

et al. 2018

Medical Journal of Australia

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In December 2015, the Royal Australian and New Zealand College of Psychiatrists published a comprehensive set of mood disorder clinical practice guidelines for psychiatrists, psychologists and mental health professionals. This guideline summary, directed broadly at primary care physicians, is an abridged version that focuses on bipolar disorder. It is intended as an aid to the management of this complex disorder for primary care physicians working in collaboration with psychiatrists to implement successful long term management. Main recommendations: The guidelines address the main phases of bipolar disorder with a particular emphasis on long term management, and provide specific clinical recommendations. Mania: All physicians should be able to detect its early signs so that treatment can be initiated promptly. At the outset, taper and cease medications with mood-elevating properties and institute measures to reduce stimulation, and transfer the patient to specialist care. Bipolar depression: Treatment is complicated and may require trialling treatment combinations. Monotherapy with mood-stabilising agents or second generation antipsychotics has demonstrated efficacy but using combinations of these agents along with antidepressants is sometimes necessary to achieve remission. Commencing adjunctive structured psychosocial treatments in this phase is benign and likely effective. Long term management: Physicians should adjust treatment to prevent the recurrence of manic and/or depressive symptoms and optimise functional recovery. Closely monitor the efficacy of pharmacological and psychological treatments, adverse effects and compliance. Changes in management as a result of the guidelines: The guidelines position bipolar disorder as part of a spectrum of mood disorders and provide a longitudinal perspective for assessment and treatment. They provide new management algorithms for the maintenance phase of treatment that underscore the importance of ongoing monitoring to achieve prophylaxis. As a first line treatment, lithium remains the most effective medication for the prevention of relapse and potential suicide, but requires nuanced management from both general practitioners and specialists. The guidelines provide clarity and simplicity for the long term management of bipolar disorder, incorporating the use of new medications and therapies alongside established treatments.

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Section: Recommendationsmentioning

confidence: 99%

Section: Clinical Recommendations For the Long Term Management Of Bipmentioning

confidence: 99%

Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for mood disorders: bipolar disorder summary

Malhi

Outhred

Morris

et al. 2018

Medical Journal of Australia

View full text Add to dashboard Cite

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“…In addition, Li is the only mood stabilizer that has demonstrated efficacy in suicide prevention. This effect of Li is unfortunately often unknown to psychiatrists [25]. Self-harm is not only a symptom, but also a prominent cause of morbidity in patients with bipolar disorder and is strongly associated with suicide.…”

Section: Discussionmentioning

confidence: 99%

The Role of Lithium Carbonate in Concept of Double Mood Stabilizer for Treatment of Bipolar Mania

Sun¹,

Fengpei²,

Jianfeng³

et al. 2019

Int J Psychiatr Res

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Background: To systematically evaluate the difference in efficacy of valproate and valproate combination with lithium carbonate for therapy of bipolar mania in China. And to provide evidences for double mood stabilizer in therapy of bipolar disorder. Methods: A meta-analysis was performed of all the literatures germane to estimate the bipolar mania patients treated with valproate combination with lithium and only valproate randomized controlled trials (RCTs) from 2007 to 2014. Odds ratios (ORs) and 95% confidence intervals (CIs) of, effective rate and remission rate were calculated and the meta-analysis was conducted with Revman5.1 software. And symptoms changes and times of relapse were also analyzed by Revman 5.1 software. Results: A total of 5 RCTs were included. The results of meta-analysis demonstrated as following: (1). The effective rate was lower in valproate group than that of valproate combination with lithium group t(24/65vs49/65, Z=4.05, P<0.0001, OR=0.49, 95CI=0.35~0.69). (2). The remission rate was lower in valproate group than that of valproate combination with lithium group (21/100vs45/100, Z=3.62, P<0.0003,. OR=0.31, 95CI=0.17~0.59). (3). The manic scale was lower found in combination group than that in valproate group (Z=6.19, P<0.0001, WMD=-2.07, 95%CI=-2.73~-1.42). (4). The times of relapse was less found in combination group than that in valproate group, but no statistic significance (Z=1.

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“…Lithium is commonly used as the first-line long-term treatment option in BD due to its potent effect on preventing both manic and depressive episodes ( 26 ) and on reducing the risk of suicide ( 27 ). In addition, lithium treatment has been associated with lower cardiovascular and all-cause mortality ( 28 – 30 ).…”

Section: Introductionmentioning

confidence: 99%

Lithium and the Interplay Between Telomeres and Mitochondria in Bipolar Disorder

et al. 2020

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Bipolar disorder is a severe psychiatric disorder which affects more than 1% of the world’s population and is a leading cause of disability among young people. For the past 50 years, lithium has been the drug of choice for maintenance treatment of bipolar disorder due to its potent ability to prevent both manic and depressive episodes as well as suicide. However, though lithium has been associated with a multitude of effects within different cellular pathways and biological systems, its specific mechanism of action in stabilizing mood remains largely elusive. Mitochondrial dysfunction and telomere shortening have been implicated in both the pathophysiology of bipolar disorder and as targets of lithium treatment. Interestingly, it has in recent years become clear that these phenomena are intimately linked, partly through reactive oxygen species signaling and the subcellular translocation and non-canonical actions of telomerase reverse transcriptase. In this review, we integrate the current understanding of mitochondrial dysfunction, oxidative stress and telomere shortening in bipolar disorder with documented effects of lithium. Moreover, we propose that lithium’s mechanism of action is intimately connected with the interdependent regulation of mitochondrial bioenergetics and telomere maintenance.

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Lithium and suicide prevention in bipolar disorder

Cited by 44 publications

References 66 publications

Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for mood disorders: bipolar disorder summary

Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for mood disorders: bipolar disorder summary

The Role of Lithium Carbonate in Concept of Double Mood Stabilizer for Treatment of Bipolar Mania

Lithium and the Interplay Between Telomeres and Mitochondria in Bipolar Disorder

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