Depression as a lethal disease: prevention strategies

Area of Science:

• Psychiatry
• Pharmacology
• Clinical Medicine

Background:

• Lithium's prophylactic effects were first investigated in 1971 through a prospective double-blind trial.
• Early trials indicated lithium reduced morbidity and need for additional treatments in unipolar and bipolar patients.

Purpose of the Study:

• To report on the long-term follow-up of patients receiving lithium treatment.
• To assess the mortality and suicide rates in a cohort of patients treated with lithium.
• To confirm the optimal therapeutic plasma lithium level for long-term maintenance.

Main Methods:

• Prospective, double-blind trials were conducted to establish lithium's efficacy and optimal dosage.
• A lithium clinic was established for regular patient monitoring (clinical state, plasma lithium levels).
• Patients were switched to a lower, optimized dosage (0.5-0.79 mmol/L plasma level) in 1982.

Main Results:

• Lithium treatment significantly reduced morbidity and the need for adjunctive medications and therapies.
• Switching to the optimized lower dosage in 1982 led to a further small but significant decline in morbidity.
• In a cohort of 103 patients followed from 1977 to 1992, there were only 2 suicides, with high compliance.

Conclusions:

• Long-term lithium treatment is effective in reducing morbidity and suicide rates in patients with mood disorders.
• The established optimal plasma lithium level (0.5-0.79 mmol/L) is confirmed as effective for long-term maintenance therapy.
• Consistent monitoring and adherence to optimized lithium dosage contribute to favorable long-term patient outcomes.