Lithium and suicide prevention in mood disorders and in the general population: A systematic review

Matto, Laura Del; Muscas, M.; Murru, Andréa; Verdolini, Norma; Anmella, Gerard; Fico, Giovanna; Corponi, Filippo; Carvalho, André F.; Samalin, Ludovic; Carpiniello, B.; Fagiolini, Andrea; Vieta, Eduard; Pacchiarotti, Isabella

doi:10.1016/j.neubiorev.2020.06.017

Cited by 90 publications

(59 citation statements)

References 65 publications

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“…Antidepressants have been reported to decrease suicidal thoughts and behaviours in adult and geriatric patients 165,166 . Literature consistently reports anti-suicidal effects of lithium, both in clinical samples and in the general population 167,168 . Other mood stabilizers, such as valproate, lamotrigine and carbamazepine, may also have an anti-suicidal effect 169 .…”

Section: Treatment Of Mental Disordersmentioning

confidence: 99%

Adaptation of evidence‐based suicide prevention strategies during and after theCOVID‐19 pandemic

et al. 2020

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Suicide is preventable. Nevertheless, each year 800,000 people die of suicide in the world. While there is evidence indicating that suicide rates de‐crease during times of crises, they are expected to increase once the immediate crisis has passed. The COVID‐19 pandemic affects risk and pro‐tective factors for suicide at each level of the socio‐ecological model. Economic downturn, augmented barriers to accessing health care, increased access to suicidal means, inappropriate media reporting at the societal level; deprioritization of mental health and preventive activities at the community level; interpersonal conflicts, neglect and violence at the relationship level; unemployment, poverty, loneliness and hopelessness at the individual level: all these variables contribute to an increase of depression, anxiety, post‐traumatic stress disorder, harmful use of alcohol, substance abuse, and ultimately suicide risk. Suicide should be prevented by strengthening universal strategies directed to the entire population, including mitigation of unemployment, poverty and inequalities; prioritization of access to mental health care; responsible media reporting, with information about available support; prevention of increased alcohol intake; and restriction of access to lethal means of suicide. Selective interventions should continue to target known vulnerable groups who are socio‐economically disadvantaged, but also new ones such as first responders and health care staff, and the bereaved by COVID‐19 who have been deprived of the final contact with loved ones and funerals. Indicated preventive strategies targeting individuals who display suicidal behaviour should focus on available pharmacological and psychological treatments of mental disorders, ensuring proper follow‐up and chain of care by increased use of telemedicine and other digital means. The scientific community, health care professionals, politicians and decision‐makers will find in this paper a systematic description of the effects of the pandemic on suicide risk at the society, community, family and individual levels, and an overview of how evidence‐based suicide preventive interventions should be adapted. Research is needed to investigate which adaptations are effective and in which con‐texts.

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Section: Treatment Of Mental Disordersmentioning

confidence: 99%

Adaptation of evidence‐based suicide prevention strategies during and after theCOVID‐19 pandemic

et al. 2020

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“…Suicidal risk was reduced during long‐term treatment of BD patients with lithium in several studies, 48–53 and its overall clinical value in the treatment of BD was reviewed recently 54 . In meta‐analyses including data from 34 trials (8 were RCTs against placebo) of long‐term treatment with lithium for a major mood disorder in more than 110,000 PEY of risk, pooled rates of suicide and attempts were five times lower during treatment with lithium compared to no treatments or other treatments, and six‐fold with BD specifically 48,50 .…”

Section: Treatmentmentioning

confidence: 99%

“…Effectiveness of lithium treatment in preventing suicide may be associated with reduced impulsivity and aggressiveness in bipolar depressive or dysphoric‐agitated mixed states, or lithium may have specific effects against suicide independent of mood‐stabilizing actions. Suicidal risk sometimes was found to be reduced even among patients whose mood‐disorder symptoms had not responded well to lithium, 53,56 although not always 53,57 …”

Section: Treatmentmentioning

confidence: 99%

Prevention of suicidal behavior in bipolar disorder

2020

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Background Excess mortality is a critical hallmark of bipolar disorder (BD) due to co‐occurring general medical disorders and especially from suicide. It is timely to review of the status of suicide in BD and to consider the possibility of limiting suicidal risk. Methods We carried out a semi‐systematic review of recent research reports pertaining to suicide in BD. Findings Suicide risk in BD is greater than with most other psychiatric disorders. Suicide rates (per 100,000/year) are approximately 11 and 4 in the adult and juvenile general populations, but over 200 in adults, and 100 among juveniles diagnosed with BD. Suicide attempt rates with BD are at least 20 times higher than in the adult general population, and over 50 times higher among juveniles. Notable suicidal risk factors in BD include: previous suicidal acts, depression, mixed–agitated‐dysphoric moods, rapid mood‐shifts, impulsivity, and co‐occurring substance abuse. Suicide‐preventing therapeutics for BD remain severely underdeveloped. Evidence favoring lithium treatment is stronger than for other measures, although encouraging findings are emerging for other treatments. Conclusions Suicide is a leading clinical challenge for those caring for BD patients. Improved understanding of risk and protective factors combined with knowledge and close follow‐up of BD patients should limit suicidal risk. Ethically appropriate and scientifically sound studies of plausible medicinal, physical, and psychosocial treatments aimed at suicide prevention specifically for BD patients are urgently needed.

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“…77 Furthermore, this subgroup may also benefit from psychopharmacological therapies with evidence of specific antisuicidal effects, such as lithium or clozapine. [78][79][80] Longacting antipsychotics might also prove beneficial in reducing suicidal risk already in these early stages. In addition to improving adherence, which can lead to better clinical and functional outcomes, treatment administration involves a frequent contact with mental health services.…”

mentioning

confidence: 99%

Trajectories of suicidal ideation after first‐episode psychosis: a growth mixture modeling approach

Salagre

Grande

Jiménez

et al. 2021

Acta Psychiatr Scand

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Objective: The period immediately after the onset of first-episode psychosis (FEP) may present with high risk for suicidal ideation (SI) and attempts, although this risk may differ among patients. Thus, we aimed to identify trajectories of SI in a 2-years follow-up FEP cohort and to assess baseline predictors and clinical/functional evolution for each trajectory of SI. Methods: We included 334 FEP participants with data on SI. Growth mixture modeling was used to identify trajectories of SI. Putative sociodemographic, clinical, and cognitive predictors of the distinct trajectories were examined using multinomial logistic regression.

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Lithium and suicide prevention in mood disorders and in the general population: A systematic review

Cited by 90 publications

References 65 publications

Adaptation of evidence‐based suicide prevention strategies during and after theCOVID‐19 pandemic

Adaptation of evidence‐based suicide prevention strategies during and after theCOVID‐19 pandemic

Prevention of suicidal behavior in bipolar disorder

Trajectories of suicidal ideation after first‐episode psychosis: a growth mixture modeling approach

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