Research on Lithium and Suicide-Related Events

According to a new research published in the Journal of the American Medical Association, adding lithium to standard Veterans Affairs mental health treatment did not diminish the occurrence of suicide-related events among veterans with significant depression or bipolar illness who had recently attempted suicide. The findings of this study suggest that in patients who are actively being treated for mood disorders and substantial comorbidities, simply adding lithium to existing medication regimens is unlikely to be effective for preventing a broad range of suicide-related events.

The research was carried out by Ira R. Katz and team and results of the research were published on 17th November, 2021.

Suicide and suicide attempts are chronic and growing public health issues. Observational research and meta-analyses of randomized clinical trials have shown that lithium may help people with bipolar illness or depression avoid suicidal ideation. As a result, this study was conducted to determine if lithium supplementation of standard therapy reduced the risk of repeating bouts of suicidal ideation in individuals with bipolar illness or depression who have survived a recent incident.

This was a randomized, double-blind, placebo-controlled clinical study that compared lithium augmentation of usual therapy to placebo in veterans with bipolar illness or depression who had survived a recent suicide-related episode. Between July 1, 2015, and March 31, 2019, veterans at 29 VA medical sites who experienced an episode of suicidal conduct or an inpatient hospitalization to prevent suicide were screened. Participants were randomly assigned to either extended-release lithium carbonate (600 mg/d) or a placebo. The parameters to be included for assessment were:

• Suicide attempts
• Halted attempts
• Hospitalizations particularly to avoid suicide
• Suicide fatalities were the first recurring suicide-related events

After 519 veterans were randomized, 255 were given lithium and 264 were given a placebo, the experiment was called off due to futility. At 3 months, mean lithium concentrations in individuals with bipolar disorder were 0.54 mEq/L and 0.46 mEq/L in patients with major depressive disorder. There was no overall difference in recurrent suicide-related incidents between treatments. There were no unexpected safety problems.

Suicide-related outcomes occurred in 127 participants: 65 in the lithium group and 62 in the placebo group. There was one fatality in the lithium group and three in the placebo group. When lithium was added to normal VA mental health therapy, the current double-blind, placebo-controlled trial demonstrated no effect of lithium above placebo in avoiding or delaying suicide-related events (suicide attempts, stopped attempts, hospitalizations to prevent attempts, or suicide fatalities).

In conclusion, simply adding lithium to existing pharmaceutical regimes is unlikely to be useful in reducing a wide range of suicide-related events in individuals being treated for mood disorders and significant comorbidities.

Reference

Katz IR, Rogers MP, Lew R, et al. Lithium Treatment in the Prevention of Repeat Suicide-Related Outcomes in Veterans With Major Depression or Bipolar Disorder: A Randomized Clinical Trial. JAMA Psychiatry. Published online November 17, 2021. doi:10.1001/jamapsychiatry.2021.3170