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Lithium Treatment in the Prevention of Repeat Suicide-Related Outcomes in Veterans With Major Depression or Bipolar Disorder

Lithium Treatment in the Prevention of Repeat Suicide-Related Outcomes in Veterans With Major... Key PointsQuestionDoes lithium augmentation of usual care reduce the rate of repeated suicide-related events in participants with bipolar disorder or depression who have survived a recent event? FindingsThis randomized clinical trial was stopped for futility after 519 veterans had been enrolled. No overall differences between lithium and placebo treatments were found. MeaningThe findings of this study suggest that in patients who are actively being treated for mood disorders and substantial comorbidities, simply adding lithium to existing medication regimens is unlikely to be effective for preventing a broad range of suicide-related events. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png JAMA Psychiatry American Medical Association

Lithium Treatment in the Prevention of Repeat Suicide-Related Outcomes in Veterans With Major Depression or Bipolar Disorder

IMPORTANCE Suicide and suicide attempts are persistent and increasing public health Editorial page 9 problems. Observational studies and meta-analyses of randomized clinical trials have Multimedia suggested that lithium may prevent suicide in patients with bipolar disorder or depression. Supplemental content OBJECTIVE To assess whether lithium augmentation of usual care reduces the rate of repeated episodes of suicide-related events (repeated suicide attempts, interrupted attempts, hospitalizations to prevent suicide, and deaths from suicide) in participants with bipolar disorder or depression who have survived a recent event. DESIGN, SETTING, AND PARTICIPANTS This double-blind, placebo-controlled randomized clinical trial assessed lithium vs placebo augmentation of usual care in veterans with bipolar disorder or depression who had survived a recent suicide-related event. Veterans at 29 VA medical centers who had an episode of suicidal behavior or an inpatient admission to prevent suicide within 6 months were screened between July 1, 2015, and March 31, 2019. INTERVENTIONS Participants were randomized to receive extended-release lithium carbonate beginning at 600 mg/d or placebo. MAIN OUTCOMES AND MEASURES Time to the first repeated suicide-related event, including suicide attempts, interrupted attempts, hospitalizations specifically to prevent suicide, and deaths from suicide. RESULTS The trial was stopped for futility after 519 veterans (mean [SD] age, 42.8 [12.4] years; 437 [84.2%] male) were randomized: 255 to lithium and 264 to placebo. Mean lithium concentrations at 3 months were 0.54 mEq/L for patients with bipolar disorder and 0.46 mEq/L for patients with major depressive disorder. No overall difference in repeated suicide-related events between treatments was found (hazard ratio, 1.10; 95% CI, 0.77-1.55). No unanticipated safety concerns were observed. A total of 127 participants (24.5%) had suicide-related outcomes: 65 in the lithium group and 62 in the...
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Publisher
American Medical Association
Copyright
Copyright 2021 American Medical Association. All Rights Reserved.
ISSN
2168-622X
eISSN
2168-6238
DOI
10.1001/jamapsychiatry.2021.3170
Publisher site
See Article on Publisher Site

Abstract

Key PointsQuestionDoes lithium augmentation of usual care reduce the rate of repeated suicide-related events in participants with bipolar disorder or depression who have survived a recent event? FindingsThis randomized clinical trial was stopped for futility after 519 veterans had been enrolled. No overall differences between lithium and placebo treatments were found. MeaningThe findings of this study suggest that in patients who are actively being treated for mood disorders and substantial comorbidities, simply adding lithium to existing medication regimens is unlikely to be effective for preventing a broad range of suicide-related events.

Journal

JAMA PsychiatryAmerican Medical Association

Published: Jan 17, 2022

References