Table 2 Studies focusing on suicide and mortality, long-term follow-up of lithium-treated patients and epidemiological studies including record linkage
From: The suicide prevention effect of lithium: more than 20 years of evidence—a narrative review
Year/country | Author | Diagnoses | Medication/type of study | Number of patients | Duration | Results |
|---|---|---|---|---|---|---|
1972/UK | Barraclough | Affective disorders | Retrospective, clinical survey | 100 suicide cases | >1/5 of these 100 suicides might have been prevented if lithium had been used | |
1977/USA | Fieve | Affective disorders | Li | 20 | 78 weeks | 0 suicide |
Retrospective cohort study | ||||||
1984/Czech Republic | Hanus and Zapletalek | Affective disorders | Li treatment compared to non-Li treatment/retrospective cohort study | 95 | 5 years | 4 SA during Li therapy |
20 % reduction | 25 SA during non-Li therapy | |||||
1991/UK | Coppen et al. | Affective disorders | Li | 103 | 11-year follow-up | 10 deaths from other causes, expected number 18.31; no suicides |
Retrospective cohort study | ||||||
1991/Denmark | Vestergaard and Aargaard | Affective disorders | Li | 133 | 5 years | No advantage |
Retrospective cohort study | ||||||
1992/Germany, Denmark, Canada, Austria | Müller-Oerlinghausen et al. (a) | Affective disorders | Li | 827 | Ø 81 months = 5600 patient-years | 44 deaths, total number of deaths was not different from what would be expected in a matched sample of the general population |
Retrospective cohort study | IGSLI cohort | |||||
1992/Germany | Müller-Oerlinghausen et al. (b) | Affective disorders | Comparison of Li treatment with non-Li treatment period | 68 | 8 years, at least 12 months of Li treatment | 2 suicides, 4 SA during Li treatment (in 55 patients) |
4 suicides, 7 SA when not Li-treated | ||||||
Retrospective cohort study | ||||||
1994/Germany | Felber and Kyber | Affective disorders | Comparison of Li treatment with non-Li treatment period | 36 | 14 years, 6.8 years with lithium, 7.2 years without lithium | 64 SA during non-Li treatment, |
7 SA during Li treatment, reduction SA 10:1, reduction suicides 3:1 | ||||||
Retrospective cohort study | ||||||
1995/Sweden | Nilsson | Affective disorders | Comparison of Li treatment with non-Li treatment period | 362 | At least 1 year of Li treatment | 129 deaths, risk to die was 1.7 times higher when not Li-treated and 4.8 times higher to commit suicide when not Li-treated |
Retrospective cohort study | ||||||
1996/Germany, Canada, Denmark, Austria, Sweden | Wolf et al. | Affective disorders | Li | 1056 | Average length of Li treatment 86.2 months | Mortality of lithium-treated patients did not differ from general population |
Retrospective cohort study | Total treatment period 90.982 months | |||||
IGSLI cohort | ||||||
1998/Italy | Bocchetta et al. | Affective disorders | Li | 100 | Ø 9.6 years observation period | 10 suicides—9 of them after discontinuation of Li therapy, suicide risk 24-fold higher when not Li-treated |
Retrospective cohort study | ||||||
1999/USA | Baldessarini et al. | Bipolar disorder | Li | 310 | Ø 6.36 years Li, of that group, 128 patients with Ø 3.7 years without lithium + 8.2 years observation period before lithium therapy | 7-fold lower rate of suicidal events during Li therapy compared to time before Li therapy rate of suicidal events 20-fold higher after discontinuation |
Retrospective cohort study | ||||||
2000/Sweden | Kallner et al. | Affective disorders | Li | 497 | 30 years | 80 % higher suicide rate when Li therapy was discontinued |
Retrospective cohort study | ||||||
2000/Denmark | Brodersen et al. | Affective disorders | Li | 133 | 2 years observation period + follow-up after 16 years | 40 deaths, including 11 suicides, mortality was twice that of general population (due to suicides), mortality from all other causes was similar; suicides occurred more often in those not compliant with therapy |
Retrospective cohort study | ||||||
2000/UK | Coppen et al. | Unipolar Bipolar Schizoaffective | Retrospective cohort study | 67 unipolar, 30 bipolar, 6 schizoaffective | 1977–1995 | 24 deaths, 21 deaths from natural causes, 2 suicides, 1 road accident, overall suicide rate was 1.3 per 1000 patient-years of observation |
Expected suicide rate per 1000 years in this population between 5.4 and 10.2 | ||||||
2001/Germany | Conell et al. | Affective disorders | Comparison of Li treatment with non-Li treatment period | 33 | Ø 10.3 years without lithium | Anti-suicidal effect did not differ after restarting the Li therapy |
Ø 19.8 years with lithium | ||||||
Response rate after discontinuation and restarting lower | ||||||
Retrospective cohort study | ||||||
2001/Germany (region Saxony) | Fülle et al. | All diagnoses | Analysis of suicide cases within all hospitals in Saxony compared to a matched control group | 800 patients including 400 suicides + 400 controls | Control group had 6 times more often lithium long-term treatment compared to suicide group | |
Lithium therapy was under-represented within the suicide group | ||||||
2001/Germany, Denmark, Austria | Ahrens et al. | Affective disorders | Li | 167 | Ø 6.7 years | Reduction of SA in excellent responders (3 SA), moderate responders (14 SA), and poor responders (21 SA) |
Retrospective cohort study | Subgroup of IGSLI cohort | 1120 treatment years | ||||
Comparison of response rates | ||||||
2001/USA | Coryell et al. | Affective disorders | Retrospective cohort study | 15 suicides compared to 15 non-suicides | 6 of suicides and 8 of controls were thought to take lithium, 9 of SA and 8 of controls were on lithium | |
41 suicide attempts compared to 41 non-SA | ||||||
2003/USA | Goodwin et al. | Bipolar disorder | Li | 20.623 | At least one prescription with Li or VLP or CBZ | Lithium-treated patients had 1.5- to 3-fold reduced suicide risk compared to VLP-treated patients |
VLP | Data from health insurances | |||||
CBZ | ||||||
Retrospective cohort study | ||||||
2005/Denmark | Kessing et al. | Li | 13.186 | Patients with at least one lithium prescription compared to patients who never received lithium | Lithium patients had 0.44-fold reduced suicide rate | |
Retrospective cohort study | Data from a national register | |||||
2005/Italy | Bocchetta et al. | Affective disorders | Li | 1394 patients | 5474 years of lithium treatment | Patients treated >5 years with lithium had reduced mortality rate (like general population) |
Retrospective cohort study | 18.154 patient years | |||||
2005/Switzerland | Angst et al. | Affective disorders | Li | 406 patients | 40 years | 45 suicides, Li-treated patients had lower suicide rate which did not differ from general population |
Prospective epidemiological study | ||||||
2006/Spain | Gonzales-Pinto et al. | Bipolar I | Li | 72 | 10 years | 5.2-fold reduced risk for suicidal behavior or SA in patients with stable and good Li response |
Prospective cohort study | ||||||
2008/USA | Collins and McFarland | Bipolar disorder | Li | 12662 patients | Overall 12 suicides, 81 SA, 2 suicides, 15 SA (Li) | |
VLP | 2558 (Li) | |||||
Other anti-convulsive medication | 2214 (VLP) | 2 suicides, 41 SA (VLP) | ||||
2002 (gabapentin) | 7 suicides, 19 SA (gabapentin) | |||||
242 (CBZ) | ||||||
4 SA (CBZ) | ||||||
Lowest (0.78) suicide rate per 1000 person years in Li-treated patients | ||||||
2009/Australia | Keks et al. | Bipolar disorder | Retrospective cohort study | 35 suicides | Only 4 of them were treated with lithium | |
2011/Germany | Neuner et al. | All diagnoses | Analysis of all suicides within psychiatric hospitals compared to a matched control group without suicides | 133 hospital suicides vs. 133 non-suicide patients | Affective disorders: 59 suicide patients (0 patients with lithium) 60 control patients (12 patients with lithium) |