June 19, 2005

Lithium Lowers Suicide Rate

Lithium has long been used to treat those with bipolar disorder, especially when they are suffering from severe manic episodes. Recent studies have indicated that a higher than thought percentage of the US population suffers from this sometimes debilitating disorder. But since the discovery of lithium and its beneficial affects on bipolar patients, new drugs have entered the pharmaceutical market. Lithium used to be almost the only thing used to help bipolar patients, but now there are plenty of other medications to choose from.

"Compared to major depressive disorder, bipolar disorder has a significantly greater impact on an individual's ability to go to work or be productive when at work, according to the NCS-R, which included face-to-face interviews with 9,282 U.S. adults. On an annual basis, the mean number of lost days for someone with bipolar disorder is 49.5, versus 31.9 for someone with major depressive disorder. Nationally, bipolar disorder carries a $25,868 billion-a-year price tag, an economic burden not before appreciated, says Dr. Kessler, who believes previous research has over-estimated the societal costs of major depression while underestimating the costs of bipolar disorder.

One significant cost associated with bipolar disorder is suicide, quantifiable in terms of both the loss of human life and its impact on society. Of particular concern is that attempts made by bipolar patients have about a one-in-five chance of being lethal, compared to a one-in-20 attempt-to-suicide rate within the general population.

In a new review article (Arch Suicide Res 2005:9(3):307-19), authors analyzed existing data from international research groups in Sweden, Italy, and the U.S. and concluded that bipolar patients on lithium had an 8-times lower suicide risk than those not taking lithium. The study concludes that: "The great number of lives potentially saved by lithium adds to the remarkable benefits of lithium in economical terms."

Although it is not clear in the article cited above whether patients taking lithium were being compared with patients taking other medications, or patients not on any sort of treatment, other studies doing direct comparisons have also shown the anti-suicidal benefits of lithium. One study from the Journal of American Medicine followed 20,638 patients for seven years who had at least one outpatient diagnosis of bipolar disorder, and were taking either lithium, carbamazapine, or divalproex. After adjusting for confounding variables (age, sex, health plan, year of diagnosis, comorbid medical and psychiatric conditions, and concomitant use of other psychotropic drugs), the authors concluded that those taking divalproex had a 2.7 times greater risk of suicide deaths than those taking lithium.

According to Ross J. Baldessarini, at Harvard Medical School , the number of suicides and attempted suicides, as well as their associated costs, could be reduced significantly in the United States by a return to more widespread use of Lithium, as had been more common before the introduction of newer drugs and continues to be standard practice in Europe. The first modern use of Lithium to treat mania was more than 55 years ago" (XagenaMedicine, 2005).

If you or someone you know has bipolar disorder and is at risk for suicide (see some of the criteria for being at risk), you might want to consider asking your doctor or psychiatrist about lithium as a possible treatment.

More resources for preventing suicide

Study abstracts (available at http://www.pubmed.com - do a search on the study title):

The impact of lithium long-term medication on suicidal behavior and mortality of bipolar patients.
Arch Suicide Res. 2005;9(3):307-19.

Suicide risk in bipolar disorder during treatment with lithium and divalproex.
JAMA. 2003 Sep 17;290(11):1467-73.

Another psychotropic medication (commonly prescribed for schizophrenia, but may be prescribed in some cases to help control the acute mania of bipolar disorder) that has been shown to help reduce suicides is clozapine. Read a news article about how clozapine might prevent suicide (BBC News, Jan 14 2003).

Always consult with your doctor before changing or adjusting your medication. A trained psychiatrist is preferable.

For more information on Bipolar Disorder Medications go to: http://www.moodswing.org/meds.html

The source of this article is XagenaMedicine and the University of Pittsburgh Medical Center.

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