Analysis of the efficacy of lithium in the prevention of suicide in patients with mood disorders: an integrative review
DOI:
https://doi.org/10.33448/rsd-v11i15.37054Keywords:
Mood disorders; Lithium; Suicide.Abstract
Background: Mood disorders refer to those whose main symptom is a change in mood or affect, altering animosity and the way of feeling, thinking and behaving. Since the 1970s, a number of primary studies have pointed to lithium's effectiveness in reducing the risk of suicide. Objectives: To carry out an integrative review of the literature on the efficacy of lithium in preventing suicide risk in patients with mood disorders. Methodology: Integrative review, which used the descriptors “lithium”, “prevention” and “suicide” in the LILACS, SciELO and PUBMED databases. Inclusion criteria were articles published in English, of the randomized clinical trial type, between 2000 and 2022, indexed in the chosen databases and available for full reading. The research was carried out according to the PRISMA flowchart for integrative and systematic reviews. Six articles were selected for review. Results and Discussion: Three studies showed that lithium did not reduce suicide attempts in patients with bipolar affective disorder (BD) or major depression. Differences in lithium doses, sociodemographic conditions, type of control group and type of mood disorder may cause the results to be discrepant when compared with each other. Conclusion: Although lithium is used to prevent suicidal behavior in patients with mood disorders, the studies analyzed showed divergent results regarding its effectiveness in this group.
References
American Psychiatric Association. (2013). DSM-V: Manual Diagnóstico e Estatístico de Transtornos Mentais (DSM-5) (5th ed.). Artmed.
Baethge, C., Tondo, L., Bratti, I. M., Bschor, T., Bauer, M., Viguera, A. C., & Baldessarini, R. J. (2003). Prophylaxis Latency and Outcome in Bipolar Disorders. The Canadian Journal of Psychiatry, 48(7), 449–457. https://doi.org/10.1177/070674370304800704
Baldessarini, R. J., Tondo, L., & Hennen, J. (2003). Lithium treatment and suicide risk in major affective disorders: update and new findings. The Journal of Clinical Psychiatry, 64 Suppl 5, 44–52. https://pubmed.ncbi.nlm.nih.gov/12720484/
Baldessarini, R. J. (2013). Chemotherapy in Psychiatry. Springer New York. https://doi.org/10.1007/978-1-4614-3710-9
Brådvik, L., Mattisson, C., Bogren, M., & Nettelbladt, P. (2008). Long-term suicide risk of depression in the Lundby cohort 1947-1997--severity and gender. Acta Psychiatrica Scandinavica, 117(3), 185–191. https://doi.org/10.1111/j.1600-0447.2007.01136.x
Benard, V., Vaiva, G., Masson, M., & Geoffroy, P. A. (2016). Lithium and suicide prevention in bipolar disorder. L’Encéphale, 42(3), 234–241. https://doi.org/10.1016/j.encep.2016.02.006
Cipriani, A., Hawton, K., Stockton, S., & Geddes, J. R. (2013). Lithium in the prevention of suicide in mood disorders: updated systematic review and meta-analysis. BMJ, 346(jun27 4), f3646–f3646. https://doi.org/10.1136/bmj.f3646
Berghöfer, A., Alda, M., Adli, M., Baethge, C., Bauer, M., Bschor, T., Glenn, T., Grof, P., Müller-Oerlinghausen, B., Rybakowski, J., Suwalska, A., & Pfennig, A. (2008). Long-Term Effectiveness of Lithium in Bipolar Disorder. The Journal of Clinical Psychiatry, 69(12), 1860–1868. https://doi.org/10.4088/jcp.v69n1203
Costa, L. da S., Alencar, Á. P., Neto, P. J. N., Santos, M. do S. V. dos, da Silva, C. G. L., Pinheiro, S. de F. L., Teixeira Silveira, R., Bianco, B. A. V., Pinheiro Júnior, R. F. F., de Lima, M. A. P., Reis, A. O. A., & Neto, M. L. R. (2015). Risk factors for suicide in bipolar disorder: A systematic review. Journal of Affective Disorders, 170, 237–254. https://doi.org/10.1016/j.jad.2014.09.003
Girlanda, F., Cipriani, A., Agrimi, E., Appino, M. G., Barichello, A., Beneduce, R., Bighelli, I., Bisoffi, G., Bisogno, A., Bortolaso, P., Boso, M., Calandra, C., Cascone, L., Castellazzi, M., Corbascio, C., Parise, V. F., Gardellin, F., Gennaro, D., Hanife, B., & Lintas, C. (2014). Effectiveness of lithium in subjects with treatment-resistant depression and suicide risk: results and lessons of an underpowered randomised clinical trial. BMC Research Notes, 7, 731. https://doi.org/10.1186/1756-0500-7-731
Harris, E. C., & Barraclough, B. (1997). Suicide as an outcome for mental disorders. British Journal of Psychiatry, 170(3), 205–228. https://doi.org/10.1192/bjp.170.3.205
Haussmann, R., Lewitzka, U., Severus, E., & Bauer, M. (2017). Sachgerechte Behandlung affektiver Störungen mit Lithium. Der Nervenarzt, 88(11), 1323–1334. https://doi.org/10.1007/s00115-017-0421-0
Horita, J. K. H. A. (2013). Lítio e sua utilização terapêutica no transtorno bipolar [Monografia apresentada ao Curso de Especialização em Análises Clínicas e Toxicológicas].
Janicak, P. (2021). Bipolar disorder in adults and lithium: Pharmacology, administration, and management of adverse effects. UpToDate, Inc. https://www.uptodate.com/contents/bipolar-disorder-in-adults-and-lithium-pharmacology-administration-and-management-of-adverse-effects?search=litio&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1#H182696807
Katz, I. R., Rogers, M. P., Lew, R., Thwin, S. S., Doros, G., Ahearn, E., Ostacher, M. J., DeLisi, L. E., Smith, E. G., Ringer, R. J., Ferguson, R., Hoffman, B., Kaufman, J. S., Paik, J. M., Conrad, C. H., Holmberg, E. F., Boney, T. Y., Huang, G. D., Liang, M. H., & Li+ plus Investigators. (2022). Lithium Treatment in the Prevention of Repeat Suicide-Related Outcomes in Veterans With Major Depression or Bipolar Disorder: A Randomized Clinical Trial. JAMA Psychiatry, 79(1), 24–32. https://doi.org/10.1001/jamapsychiatry.2021.3170
Kleindienst, N., & Greil, W. (2000). Differential Efficacy of Lithium and Carbamazepine in the Prophylaxis of Bipolar Disorder: Results of the MAP Study. Neuropsychobiology, 42(1), 2–10. https://doi.org/10.1159/000054844
Lauterbach, E., Felber, W., Müller-Oerlinghausen, B., Ahrens, B., Bronisch, T., Meyer, T., Kilb, B., Lewitzka, U., Hawellek, B., Quante, A., Richter, K., Broocks, A., & Hohagen, F. (2008). Adjunctive lithium treatment in the prevention of suicidal behaviour in depressive disorders: a randomised, placebo-controlled, 1-year trial. Acta Psychiatrica Scandinavica, 118(6), 469–479. https://doi.org/10.1111/j.1600-0447.2008.01266.x
Malhi, G. S., Gessler, D., & Outhred, T. (2017). The use of lithium for the treatment of bipolar disorder: Recommendations from clinical practice guidelines. Journal of Affective Disorders, 217, 266–280. https://doi.org/10.1016/j.jad.2017.03.052
Malloy-Diniz, L. F., Neves, F. S., de Moraes, P. H. P., De Marco, L. A., Romano-Silva, M. A., Krebs, M.-O., & Corrêa, H. (2011). The 5-HTTLPR polymorphism, impulsivity and suicide behavior in euthymic bipolar patients. Journal of Affective Disorders, 133(1), 221–226. https://doi.org/10.1016/j.jad.2011.03.051
Moreno, D. H., Dias, R. S., Moreno, R. A. Transtornos do humor. In: Louzã Neto, M. R., Elkis, H. (2007). Psiquiatria básica (2th ed). Artmed, 2007.
Nery-Fernandes, F., & Miranda-Scippa, Â. (2013). Comportamento suicida no transtorno afetivo bipolar e características sociodemográficas, clínicas e neuroanatômicas associadas. Archives of Clinical Psychiatry (São Paulo), 40(6), 220–224. https://doi.org/10.1590/s0101-60832013000600003
Oquendo, M. A., Galfalvy, H. C., Currier, D., Grunebaum, M. F., Sher, L., Sullivan, G. M., Burke, A. K., Harkavy-Friedman, J., Sublette, M. E., Parsey, R. V., & Mann, J. J. (2011). Treatment of suicide attempters with bipolar disorder: a randomized clinical trial comparing lithium and valproate in the prevention of suicidal behavior. The American Journal of Psychiatry, 168(10), 1050–1056. https://doi.org/10.1176/appi.ajp.2011.11010163
Perugi, G., Sani, G., & Tondo, L. (2019). Practical Guide to the Use of Lithium in the Treatment of Bipolar Disorder Patients. About Books.
Petkevicius, G. A. de M., Roscoche, K. G. C., Soares, A. B. S., Sousa, A. A. S. de, Aguiar, A. S. C. de, & Felício, J. F. (2020). Perfil clínico – epidemiológico de pessoas com transtorno bipolar em internação psiquiátrica. Research, Society and Development, 9(9), e394997282. https://doi.org/10.33448/rsd-v9i9.7282
Post, R. M., Leverich, G. S., Kupka, R. W., Keck, P. E., McElroy, S. L., Altshuler, L. L., Frye, M. A., Luckenbaugh, D. A., Rowe, M., Grunze, H., Suppes, T., & Nolen, W. A. (2010). Early-Onset Bipolar Disorder and Treatment Delay Are Risk Factors for Poor Outcome in Adulthood. The Journal of Clinical Psychiatry, 71(07), 864–872. https://doi.org/10.4088/jcp.08m04994yel
Rucci, P., Frank, E., Kostelnik, B., Fagiolini, A., Mallinger, A. G., Swartz, H. A., Thase, M. E., Siegel, L., Wilson, D., & Kupfer, D. J. (2002). Suicide Attempts in Patients With Bipolar I Disorder During Acute and Maintenance Phases of Intensive Treatment With Pharmacotherapy and Adjunctive Psychotherapy. American Journal of Psychiatry, 159(7), 1160–1164. https://doi.org/10.1176/appi.ajp.159.7.1160
Secretaria de Vigilância em Saúde - Ministério da Saúde. (2021). Mortalidade por suicídio e notificações de lesões autoprovocadas no Brasil. https://www.gov.br/saude/pt-br/centrais-de-conteudo/publicacoes/boletins/epidemiologicos/edicoes/2021/boletim_epidemiologico_svs_33_final.pdf
Sher, L. (2020). An infectious disease pandemic and increased suicide risk. Brazilian Journal of Psychiatry, 42(3), 239–240. https://doi.org/10.1590/1516-4446-2020-0989
Sousa, L. M. M., Furtado Firmino, C., Alves Marques-Vieira, C. M., Silva Pedro Severino, S., & Castelão Figueira Carlos Pestana, H. (2018). Revisões da literatura científica: tipos, métodos e aplicações em enfermagem. Revista Portuguesa de Enfermagem de Reabilitação, 1(1), 45–55. https://doi.org/10.33194/rper.2018.v1.n1.07.4391
Stokes, P. R. A., Jokinen, T., Amawi, S., Qureshi, M., Husain, M. I., Yatham, L. N., Strang, J., & Young, A. H. (2020). Pharmacological Treatment of Mood Disorders and Comorbid Addictions: A Systematic Review and Meta-Analysis: Traitement Pharmacologique des Troubles de L’humeur et des Dépendances Comorbides: Une Revue Systématique et une Méta-Analyse. The Canadian Journal of Psychiatry, 65(11), 749–769. https://doi.org/10.1177/0706743720915420
Tondo, L., Alda, M., Bauer, M., Bergink, V., Grof, P., Hajek, T., Lewitka, U., Licht, R. W., Manchia, M., Müller-Oerlinghausen, B., Nielsen, R. E., Selo, M., Simhandl, C., & Baldessarini, R. J. (2019). Clinical use of lithium salts: guide for users and prescribers. International Journal of Bipolar Disorders, 7(1). https://doi.org/10.1186/s40345-019-0151-2
World Health Organization. Suicide. World Health Organization, https://www.who.int/news-room/factsheets/detail/suicide (2021, accessed 28 May 2020).
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