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Excess cardiovascular and suicide mortality of affective disorders may be reduced by lithium prophylaxis
B Ahrens1, B Müller-Oerlinghausen, M Schou
1Department of Psychiatry, Freie Universität Berlin, Germany.
Insights
Long-term lithium treatment may reduce suicide risk in patients with affective disorders. While overall mortality remains similar to the general population, lithium appears to lower the significantly elevated suicide rates seen in untreated patients.
Area of Science:
- Psychiatry
- Pharmacology
- Epidemiology
Background:
- Patients with affective disorders exhibit significantly higher mortality rates than the general population.
- This excess mortality is attributed to both suicides and cardiovascular disease.
- Long-term lithium treatment's impact on cause-specific mortality in these patients requires further investigation.
Purpose of the Study:
- To investigate whether long-term lithium treatment reduces suicide frequency or cardiovascular mortality in patients with affective disorders.
- To compare cause-specific mortality rates in lithium-treated patients with those of the general population and untreated patients.
Main Methods:
- Analysis of data from 827 previously studied patients.
- Single-case analysis to estimate overall and cause-specific mortalities.
- Comparison of observed deaths to expected deaths based on general population rates.
Main Results:
- Overall mortality in lithium-treated patients was not significantly different from the general population (Standard Mortality Ratio = 1.14).
- Suicide rates were significantly lower compared to untreated patients with affective disorders (Standard Mortality Ratio = 5.22 observed vs. 1.3 expected).
- Cardiovascular mortality was not elevated in the lithium-treated group compared to the general population.
Conclusions:
- Findings suggest long-term lithium treatment may counteract excess suicide mortality associated with affective disorders.
- While not definitively proven due to ethical/practical limitations of placebo-controlled trials, observations are compatible with lithium's protective effect.
- Lithium treatment appears to normalize overall mortality and reduce suicide risk without increasing cardiovascular mortality.
Abstract:
The mortality of patients suffering from affective disorders is much higher than that of the general population; this excess is due to both suicides and cardiovascular disease. During long-term lithium treatment, the overall mortality has not been found to differ significantly from that of the general population but the question remains whether this lowering, if it is in fact caused by lithium, is due to a reduction in suicide frequency or cardiovascular mortality, or both. We analysed data from 827 previously studied patients and used a procedure that estimated both overall mortality and cause-specific mortalities by single-case analysis. For overall mortality, the ratio of observed deaths (among the patients) to expected deaths (in the general population) was 1.14, which is not significantly different from 1.0; this was also found in our previous analysis. In the whole patient group, comprising 5600 patient years under lithium treatment, seven suicides were observed and 1.3 expected, resulting in a standard mortality ratio of 5.22; this is significantly > 1.0, but markedly lower than that found in patients with affective disorders not given lithium. Cardiovascular mortality was not found to be higher in our patients than in the general population. In view of the fact that a placebo-controlled mortality study under long-term conditions is neither ethically nor practically feasible, our findings cannot prove definitively that long-term lithium treatment counteracts factors responsible for the excess suicide and cardiovascular mortality of affective disorders. However, our observations are compatible with such a notion.