Magazine article Insight on the News

Lithium Prevents Suicides

Magazine article Insight on the News

Lithium Prevents Suicides

Article excerpt

An old drug has gained new legitimacy: Psychiatrists say lithium can prevent suicide, although many doctors had abandoned the treatment.

Researchers long have recognized that lithium helps stabilize mental disorders, especially wild mood swings associated with manic depression. But a recent study shows that the drug, one of the oldest available to psychiatrists, can dramatically help patients at risk for suicide.

On average, lithium treatments reduce the risk of suicide by at least sixfold, according to the study, a review of 28 previous studies involving 17,000 patients. Patients who abruptly stopped taking lithium showed a striking increase in suicidal behavior.

"What we have here is the first treatment in psychiatry to prevent death," says Frederick K. Goodwin, a professor of psychiatry at George Washington University in the nation's capital and former director of the National Institute of Mental Health. "If this were a drug to prevent heart disease, cancer or AIDS, it would be all over the front pages."

As a result of the study, a group of leading psychiatrists has recommended that lithium be the first line of defense in treating suicidal patients. "It is important that physicians are aware of these findings, especially during the spring -- a time when, ironically, the number of suicides peak in this country," said Kay Redfield Jamison, professor of psychiatry at Johns Hopkins University School of Medicine in Baltimore and a coauthor of the report. More than 32,000 people commit suicide every year.

Lithium, a crystalline salt, was first used for mental illnesses in 1949, although it was not widely prescribed in the United States until the 1970s. It is not yet clear how the drug works. Researchers speculate it may help enhance seratonin, a brain chemical that acts as a messenger among nerve cells. Low levels of seratonin are associated with impulsive or aggressive behavior, including suicide.

Currently, lithium is less widely prescribed than newer medications. "In clinical practice, doctors are abandoning lithium and are using other, newer antidepressants, even though evidence of their long-term benefits is not proven," says Ross Baldessarini, a professor of psychiatry and neuroscience at Harvard Medical School who helped write the report.

The only study directly comparing lithium with other drugs, done in Germany in 1996, concluded that lithium was "superior" in preventing suicides. A group of 189 patients on lithium had no suicides, while two comparable groups of 90 and 100 patients on other drugs had four and five deaths respectively.

New, unpublished research suggests that the nervous system adapts to lithium and reacts strongly if it is withdrawn abruptly. …

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