Antisuicidal Effects in Mood Disorders: Are They Unique to Lithium?

Tondo, Leonardo; Baldessarini, Ross J.

doi:10.1055/a-0596-7853

Cited by 50 publications

(33 citation statements)

References 136 publications

(163 reference statements)

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“…Differently from antidepressants, lithium treatment has been associated with a significant reduction in suicide risk and suicide attempts in patients with bipolar disorder or major depressive disorder, so much so that the American Psychiatric Association has put this statement in its Practice Guidelines for the assessment of patients with suicidal behavior from 2003 [ 109 ]. These effects have been confirmed in a recent metanalysis [ 110 ]. Interestingly, although for the most part of anti-suicidal treatments achieve their objective by treating depressive correlates, lithium has been described as reducing suicidal behaviors independently from mood improvement [ 111 ].…”

Section: Eradicating the Roots Of Suicide: Neurobiological Bases Osupporting

confidence: 62%

Eradicating Suicide at Its Roots: Preclinical Bases and Clinical Evidence of the Efficacy of Ketamine in the Treatment of Suicidal Behaviors

Berardis

Fornaro

Valchera³

et al. 2018

IJMS

151

114

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Despite the continuous advancement in neurosciences as well as in the knowledge of human behaviors pathophysiology, currently suicide represents a puzzling challenge. The World Health Organization (WHO) has established that one million people die by suicide every year, with the impressive daily rate of a suicide every 40 s. The weightiest concern about suicidal behavior is how difficult it is for healthcare professionals to predict. However, recent evidence in genomic studies has pointed out the essential role that genetics could play in influencing person’s suicide risk. Combining genomic and clinical risk assessment approaches, some studies have identified a number of biomarkers for suicidal ideation, which are involved in neural connectivity, neural activity, mood, as well as in immune and inflammatory response, such as the mammalian target of rapamycin (mTOR) signaling. This interesting discovery provides the neurobiological bases for the use of drugs that impact these specific signaling pathways in the treatment of suicidality, such as ketamine. Ketamine, an N-methyl-d-aspartate glutamate (NMDA) antagonist agent, has recently hit the headlines because of its rapid antidepressant and concurrent anti-suicidal action. Here we review the preclinical and clinical evidence that lay the foundations of the efficacy of ketamine in the treatment of suicidal ideation in mood disorders, thereby also approaching the essential question of the understanding of neurobiological processes of suicide and the potential therapeutics.

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Section: Eradicating the Roots Of Suicide: Neurobiological Bases Osupporting

confidence: 62%

Eradicating Suicide at Its Roots: Preclinical Bases and Clinical Evidence of the Efficacy of Ketamine in the Treatment of Suicidal Behaviors

Berardis

Fornaro

Valchera³

et al. 2018

IJMS

151

114

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show abstract

“…Lithium is the gold standard in treating bipolar disorders, showing established effectiveness in the treatment of acute mania as well as prevention of manic and depressive episodes along with antisuicidal effects [1][2][3][4][5]. While overall prescription rates have recently decreased, possibly related to issues of toxicity and side effects, polypharmacy involving lithium has increased [1,6].…”

Section: Introductionmentioning

confidence: 99%

Drug-Drug Interactions Between Lithium and Cardiovascular as Well as Anti-Inflammatory Drugs

et al. 2020

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Introduction Lithium is the gold standard in treating bipolar affective disorders. As patients become increasingly older, drug-drug interactions leading to decreased excretion of lithium represent a key issue in lithium safety. As no study considered the effect of comedications on lithium serum concentration in combination, we aimed to quantify the impact of drugs affecting renal blood flow and function and thus potentially interacting drugs (diuretics, ACE inhibitors, AT1 antagonists, and non-steroidal anti-inflammatory drugs) on lithium serum levels in addition to age, sex, and sodium and potassium serum levels as well as renal function. Methods Retrospective data of lithium serum levels were analyzed in 501 psychiatric inpatients (2008–2015) by means of linear regression modelling. Results The number of potentially interacting drugs was significantly associated with increasing serum levels of lithium in addition to the established factors of age, renal function, and sodium concentration. Additionally, absolute lithium levels were dependent on sex, with higher values in females. However, only NSAIDs were identified to increase lithium levels independently. Discussion Routine clinical practice needs to focus on drugs affecting renal blood flow and function, especially on NSAIDs as over-the-counter medication that may lead to an increase in lithium serum concentration. To prevent intoxications, clinicians should carefully monitor the comedications, and they should inform patients about possible intoxications due to NSAIDs.

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“…Indeed, it is an intriguing medication for many reasons: it is a simple trace element found in the periodic table, yet it has demonstrated a unique, striking efficacy in preventing mood episodes in patients with bipolar and unipolar mood disorders. For example, during the past 30 years, lithium’s value as a suicide‐preventing agent has been acknowledged increasingly (4) and spurred new interest in its use. The ability of lithium to reduce suicidal risk distinguishes it from the other marketed mood‐stabilizing drugs.…”

mentioning

confidence: 99%

Lithium: about discrepancies between efficacy and clinical use

Bauer

2020

Acta Psychiatr Scand

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Antisuicidal Effects in Mood Disorders: Are They Unique to Lithium?

Cited by 50 publications

References 136 publications

Eradicating Suicide at Its Roots: Preclinical Bases and Clinical Evidence of the Efficacy of Ketamine in the Treatment of Suicidal Behaviors

Eradicating Suicide at Its Roots: Preclinical Bases and Clinical Evidence of the Efficacy of Ketamine in the Treatment of Suicidal Behaviors

Drug-Drug Interactions Between Lithium and Cardiovascular as Well as Anti-Inflammatory Drugs

Lithium: about discrepancies between efficacy and clinical use

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