This has been a year with lots of useful information highlighting the continued importance of some of the oldest treatments for bipolar disorder: lithium salts.
A New York Times Magazine article (“I Don’t Believe in Good but I Believe in LIthium”) about bipolar focused on lithium, and another New York Times article a year before that asked the question “Should We All Take a Little Lithium?”
Finally, an important set of studies suggested that lithium may have fewer serious long term side effects than was previously thought.
Now comes an article in JAMA Psychiatry that adds to the literature suggesting that lithium prevents suicide and perhaps even violence towards others.
This is not a new finding. A meta-analysis of 48 trials previously suggested that suicide is less likely in people prescribed lithium than placebo or other medications, but these findings have not been consistent.
As summarized in the American Psychiatric Association’s Psychiatric News, the findings were pretty compelling –
Joseph F. Hayes, M.Sc., M.B.Ch.B., of the University College London and coauthors compared rates of self-harm, unintentional injury (for example, falls or car accidents), and suicide deaths in patients diagnosed with bipolar disorder who were prescribed lithium, valproate, olanzapine, or quetiapine as a maintenance mood stabilizer using a large database of primary care electronic health records (EHRs) in the United Kingdom.
The team of researchers analyzed EHR data from 6,671 patients with bipolar disorder (2,148 prescribed lithium, 1,670 prescribed valproate, 1,477 prescribed olanzapine, and 1,376 prescribed quetiapine), collected between 1995 and 2013. They found that self-harm rates were lower in patients prescribed lithium (175-241 per 10,000 person-years at risk [PYAR]) compared with those prescribed valproate (334-460 per 10,000 PYAR), olanzapine (345-483 per 10,000 PYAR), or quetiapine (489-692 per 10,000 PYAR). Rates of unintentional injury were also lower in people taking lithium compared with those taking valproate or quetiapine but not olanzapine.
Confirming these findings, another set of researchers examined follow up data on 51,535 individuals with bipolar disorder who were treated between 2005 to 2013 with either lithium or valproate, or the combination of medications.
“During follow-up, 10,648 suicide-related events occurred. The incidence rate was significantly decreased by 14% during lithium treatment (hazard ratio 0.86, 95% confidence interval [CI] 0.78–0.95) but not during valproate treatment (hazard ratio 1.02, 95% CI 0.89–1.15).”
Cipriani A, Hawton K, Stockton S, Geddes JR. Lithium in the prevention of suicide in mood disorders: updated systematic review and meta-analysis. BMJ. 2013;346:f3646.
Hayes JF, Pitman A, Marston L, et al. Self-harm, Unintentional Injury, and Suicide in Bipolar Disorder During Maintenance Mood Stabilizer Treatment: A UK Population-Based Electronic Health Records Study. JAMA Psychiatry. Published online May 11, 2016. doi:10.1001/jamapsychiatry.2016.0432.
Suicidal Behavior During Lithium and Valproate Treatment: A Within-Individual 8-Year Prospective Study of 50,000 Patients With Bipolar Disorder. Jie Song, Arvid Sjölander, Erik Joas, Sarah E. Bergen, Bo Runeson, Henrik Larsson, Mikael Landén, and Paul Lichtenstein. American Journal of Psychiatry 0 0:0 2017