Tuesday, November 23, 2021

Lithium Does Not Appear to Lower Risk of Suicidal Behavior in Veterans With Mood Disorders

Adding lithium to the treatment plan of veterans with depression or bipolar and recent suicidal behavior does not appear to reduce the risk of subsequent suicidal behavior, according to a report in JAMA Psychiatry.

“The present double-blind, placebo-controlled study found no benefit of lithium over placebo for preventing or delaying suicide-related events (suicide attempts, interrupted attempts, hospitalizations to prevent attempts, or deaths from suicide) when it was added to usual VA mental health management,” wrote Ira R. Katz, M.D., Ph.D., emeritus professor of psychiatry at the University of Pennsylvania Perelman School of Medicine, and colleagues. “However, lithium still has a role in the management of mood disorders, especially bipolar disorder.”

Veterans at 29 VA medical centers who had an episode of suicidal behavior or an inpatient admission to prevent suicide within the past six months were randomized to receive lithium or placebo in addition to their existing medications and treatment. Individuals were included in the study if they had a DSM-IV-TR diagnosis of major depression or bipolar disorder; they were excluded if they had schizophrenia, six or more lifetime suicide attempts, or had used lithium within the past six months.

Katz and colleagues tracked the occurrence of any suicide-related events in the participants for one year.

The trial was halted for futility after 519 participants had been randomized (255 with lithium and 264 with placebo), as the data indicated no difference in suicide-related events between the participants who received lithium and those who received placebo. A total of 127 participants (24.5%) had suicide-related outcomes: 65 in the lithium group and 62 in the placebo group. One death occurred in the lithium group and three in the placebo group.

The authors cautioned that their data had some notable limitations, including that only half of participants assigned to lithium achieved clinically adequate blood levels of the medication (0.5 mEq/L or higher).

“Our findings are not necessarily generalizable to other health care settings or to other patient populations with differing proportions of individuals with bipolar disorder, lower rates of comorbidities, or higher treatment adherence,” Katz and colleagues wrote.

In an accompanying editorial, Ross J. Baldessarini, M.D., and Leonardo Tondo, M.D., M.S., of Harvard Medical School suggest that the report should be read with the study limitations in mind. “In our opinion, this rigorously designed and conducted trial has much to teach but cannot be taken as evidence that lithium treatment is ineffective regarding suicidal risk.”

They added, “The new trial did not find evidence of an antisuicidal effect of adding lithium to complex treatment regimens in relatively small numbers of mostly male veterans with complex, although realistic, psychopathological conditions, given relatively brief treatment with low circulating levels of lithium. Thus, its findings cannot be taken as evidence that lithium lacks antisuicidal effects.”

For related information, see the Psychiatric Services article “Suicide Mortality Among Veterans Health Administration Care Recipients With Suicide Risk Record Flags.”

(Image: iStock/Chinnapong)

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