Mortality of patients who dropped out from regular lithium prophylaxis: a collaborative study by the International Grow for the Study of Lithium‐Treated Patieits (IGSLI)

Abstract

Excess mortality has repeatedly been found in patients with recurrent affective disorders. In previous studies our group has shown that during long-term lithium treatment the mortality of such patients is not significantly higher than that of the general population. In the present study, we extended our investigation to 273 patients from the earlier IGSLI cohort who subsequently dropped out from regular lithium prophylaxis. The standardized mortality ratio (SMR) for the whole group was 2.5, significantly higher (P < 0.01) than 1.0, which is the SMR of the general population. Furthermore, the SMR of the patients from each of the participating countries, namely Denmark, Germany and Austria, was significantly higher than 1.0. These findings strengthen the evidence accumulated in previous investigations that regular long-term lithium treatment does in fact markedly reduce the excess mortality of patients with recurrent affective disorders.

A prospective 4–5 year follow‐up of juvenile onset bipolar disorder

“…However, other studies have reported high rates of substance abuse and mixed episodes (1, 4, 7, 36, 37), rapid cycling (38) and suicide attempts (7, 39, 40). This opens up the argument whether lithium is as efficacious in preventing suicide in juveniles as it has been shown to in adults (9–12). Also, the comorbidity patterns and course could be somewhat different in populations drawn from different cultural contexts.…”

“…Data from adults with bipolar disorder shows that treatment has an effect on the course and outcome of bipolar disorder (8). The prophylactic efficacy and anti‐suicidal properties of lithium have been much researched (9–12). Open trials of 4–24 weeks duration (13–15) and one double blind placebo controlled 6‐week trial (16) have evaluated lithium and other thymoleptics in children and adolescents.…”

Identifying and improving non‐adherence in bipolar disorders

“…Muller‐Oerlinghausen et al. (36, 37) have published a series of papers that demonstrate that continuous use of lithium may reduce the risk of attempted or actual suicide and that stopping lithium increases the risk of death from suicide or other physical disorders, particularly cardiovascular disorders. Their largest collaborative study of over 5500 patient‐years showed that adequate long‐term lithium treatment significantly reduced and even normalized the excess mortality rates found in patients with mood disorders.…”

Mood stabilizers in the prevention of recurrent affective disorders: a meta‐analysis

“…Two studies found that the SMR of bipolar patients returned to normal during lithium treatment (27,28). The SMR also increases when patients stop taking their lithium (28,29). Suicide is a factor in this.…”