Lithium and the Prevention of Suicidality – Highlights from RCPsychIC 2019
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This article is based on the talk by Prof Allan Young at RCPsychIC 2019. He is Chair of Mood Disorders, Director of the Centre for Affective Disorders in the Department of Psychological Medicine
Institute of Psychiatry at King’s College London.
1.Lithium, an element rather than a manufactured drug, is mainly associated with the prevention of manic recurrence, but also produces powerful effects in major depressive disorder. (Guidelines on the management of bipolar disorder; Guidelines on the management of depression)
2. As a monotherapy, it is effective only in a minority of patients, which calls for biomarker or stratified medicine studies.
3. The narrow therapeutic index and long-term renal effects are reasons for targeting lithium to people who respond. Lithium and its practical clinical application
4. However, the pharmacology of lithium is still unclear, and the mechanism of action and time course of effects remain uncertain.
5. A study of lithium vs placebo in long-term treatment showed the prevention of any relapse or recurrence was greater with lithium than placebo, and there was an acute antimanic effect. [Geddes J et al., 2004]
6. Several meta-analyses over the years have shown that lithium prevents suicide and suicidal acts in unipolar and bipolar disorder, and also reduces all-cause mortality.[Cipriani A et al.,2013], [Baldessarini R et al.,2003]
7. Problems exist in how we define lithium response regarding efficacy and anti-suicidality. A large European grant, the R-LINK protocol, will be used to personalise the evaluation of response, including suicidality of patients with bipolar I disorder. The consortium will look at all potential biomarkers of lithium response. (Learn More)
8. Lithium in the environment is in drinking water, and concentration levels vary considerably across the world. A study from Texas suggested that higher rates of lithium in the groundwater were associated with lower rates of suicide and drug addiction.[Kapusta N et al., 2011]
9. Several publications since have suggested that an inverse relationship exists between environmental lithium levels and the rates of suicide at a population level. Negative studies also exist and tend to be from geographical areas which have more mobile populations.
10. Biomarkers may revitalise the clinical use of lithium, and as it has been shown to reduce suicide in RCTs and environmentally, we need to understand this better.
References
Bipolar Disorder researchers awarded international grant. NIHR Maudsley Biomedical Research Centre website. Available at: https://www.maudsleybrc.nihr.ac.uk/posts/2018/january/bipolar-disorder-researchers-awarded-international-grant/. Accessed 01 August 2019.