June 27, 2013

expert reaction to lithium reducing suicide in mood disorders

A review published in the BMJ found drug lithium to be an effective treatment for reducing the risk of suicide and possibly deliberate self harm in people with mood disorders.

Dr Daniel Smith, Reader in Psychiatry, Institute of Health and Wellbeing, University of Glasgow, said:

“This is an important study because it brings together data from 48 randomised controlled trials of the long-term treatment of mood disorders.  Overall, it appears that lithium has an important anti-suicidal effect in depression and bipolar disorder, although the precise mechanism of this effect is not fully understood. 

“Clinically, this paper should make doctors and patients think about the long-term benefits of lithium therapy for major mood disorders such as bipolar disorder.  It’s probably fair to say that lithium has in recent years been under-prescribed for bipolar disorder – this paper may help to reverse this trend.”

Prof Allan Young, Chair of the Royal College of Psychiatrists’ Psychopharmacology Committee and Chair of Mood Disorders at the Institute of Psychiatry, said:

“This result is in keeping with much previous work that shows that lithium reduces suicide when used as a treatment in severe mood disorders.

“Lithium is a licensed treatment for severe mood disorders and this evidence adds to knowledge of its benefits. It should be administered as part of an on-going care package where the risks and potential adverse effects are fully explained. Long term monitoring is essential.”

“The authors comment that lithium’s effects are mediated by reducing relapse of the underlying mood disorder but additional mechanisms may also play a role.  Although the mechanism of action of lithium is not fully understood a key feature may be lithium’s effects to restrain aggression and impulsivity. This may explain why it is useful in a number of areas, including suicide, where increased impulsivity and aggression may play a role.”

‘Lithium in the prevention of suicide in mood disorders: updated systematic review and meta-analysis’ by Cipriani et al. published in the BMJ on Thursday 27 June 2013.