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Lithium has ‘important clinical role' in reducing risk of suicide

Lithium reduces the risk of suicide and total death by 60% in people with unipolar and bipolar disorders and should have a continued role in treating these disorders, concludes a new UK analysis.

 

The study

UK researchers looked for evidence comparing lithium with placebo or other active drugs for long term treatment (at least three months) in mood disorders. Some 48 randomised controlled trials were included in the systematic review and meta-analysis. The trials involved 6,674 participants aged 18 years or older.

The findings

Lithium was associated with reduced number of suicides (odds ratio of 0.13), and deaths from any cause (OR 0.38) when compared with placebo.  It was not as effective in preventing deliberate self harm when compared with placebo (OR 0.60), but it reduced the number of deliberate self harm episodes when compared with carbamazepine (OR 0.14). In general, lithium was better than the active comparators. In patients with unipolar depressive disorders, lithium had a protective effect against suicide (OR 0.13) and death (OR 0.36). Lithium reduced the risk of death and suicide by more than 60% compared with placebo. Sensitivity analyses found that lithium had significantly better results than anticonvulsants for deliberate self harm.

What this means for GPs

The authors concluded that their study indicates ‘lithium should continue to have an important clinical role’. The authors acknowledged the adverse effects associated with lithium therapy ‘are of particular concern to clinicians and patients’, but advised that ‘clinical decision making will need to take a balanced view of the likely benefits and harm of lithium in the individual patient’.

BMJ 2013;346:f3646

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Readers' comments (2)

  • Vinci Ho

    Actually this is a quite good report of this meta-analysis in BMJ.
    Most patients in GP on Lithium are bipolar . But we all have difficult unipolar depressed patients who had multiple suicide attempts in the past and antidepressants did not appear to be effective . This report certainly gave green light for Lithium to be used in unipolar disorder to prevent suicide .
    Interestingly ,effect on deliberate self harm was not statistically significant as odd ratio of 0.6 fell outside 95% confidence level.
    It was probably a difficult meta-analysis to do as over 60 articles were excluded out of 116 eligible ones , hence 48 studies included. There was a lot of heteogenicity amongst these studies . For instance , duration of study varied 4-48 months with a mean of only 19 months.
    Author also brought an interesting point that Lithium effect on suicide was probably specific , independent of its effect on the mood . Further research on its neuropharmacology was encouraged.

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  • Perhaps Mr Hunt should read this. I can see his new policy - "All GPs forced to take Lithium as new qof target".... ;)

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