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Lithium Treatment in the Prevention of Repeat Suicide-Related Outcomes in Veterans With Major Depression or Bipolar Disorder: A Randomized Clinical Trial.
- Source :
-
JAMA psychiatry [JAMA Psychiatry] 2022 Jan 01; Vol. 79 (1), pp. 24-32. - Publication Year :
- 2022
-
Abstract
- Importance: Suicide and suicide attempts are persistent and increasing public health problems. Observational studies and meta-analyses of randomized clinical trials have suggested that lithium may prevent suicide in patients with bipolar disorder or depression.<br />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.<br />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.<br />Interventions: Participants were randomized to receive extended-release lithium carbonate beginning at 600 mg/d or placebo.<br />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.<br />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 placebo group. One death occurred in the lithium group and 3 in the placebo group.<br />Conclusions and Relevance: In this randomized clinical trial, the addition of lithium to usual Veterans Affairs mental health care did not reduce the incidence of suicide-related events in veterans with major depression or bipolar disorders who experienced a recent suicide event. Therefore, simply adding lithium to existing medication regimens is unlikely to be effective for preventing a broad range of suicide-related events in patients who are actively being treated for mood disorders and substantial comorbidities.<br />Trial Registration: ClinicalTrials.gov Identifier: NCT01928446.
- Subjects :
- Adult
Antimanic Agents pharmacology
Antimanic Agents therapeutic use
Antipsychotic Agents pharmacology
Antipsychotic Agents therapeutic use
Bipolar Disorder psychology
Depressive Disorder, Major psychology
Double-Blind Method
Female
Humans
Lithium pharmacology
Lithium therapeutic use
Male
Middle Aged
Outcome Assessment, Health Care methods
Suicidal Ideation
Suicide, Attempted psychology
Suicide, Attempted statistics & numerical data
Veterans psychology
Veterans statistics & numerical data
Bipolar Disorder complications
Depressive Disorder, Major complications
Lithium standards
Outcome Assessment, Health Care statistics & numerical data
Suicide, Attempted prevention & control
Subjects
Details
- Language :
- English
- ISSN :
- 2168-6238
- Volume :
- 79
- Issue :
- 1
- Database :
- MEDLINE
- Journal :
- JAMA psychiatry
- Publication Type :
- Academic Journal
- Accession number :
- 34787653
- Full Text :
- https://doi.org/10.1001/jamapsychiatry.2021.3170