Psychopharmacology Tips

Lithium maintenance treatment may be an antisuicide measure in patients of bipolar disorder, even if lithium is not sufficient to reduce episodes. Researchers have observed some patients who were showing inadequate mood response to lithium who committed suicide after discontinuation, apparently because of the loss of separate antisuicide effect of lithium independent of its clinical effect on the affective episode (Muller-Oerlinghausen et al., 1992; Tondo et al., 1998). A metaanalysis detected a 20-fold increased incidence of suicide in those who stop lithium in year 1 vs. those who continue lithium prophylaxis (Baldessarini et al., 1999). These findings necessitate that the clinicians should monitor their patients for suicidal ideation after discontinuation of lithium.

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Baldessarini, R.J., Tondo, L. & Hennen, J. (1999) Effects of lithium treatment and its discontinuation on suicidal behaviour in bipolar manic-depressive disorders. Journal of Clinical Psychiatry, 60 (suppl 2), 77-84.

Muller-Oerlinghausen, B., Muser-Causemann, B. & Volk, J. (1992) Suicides and parasuicides in a high-risk patient group on and off lithium long-term medication. Journal of Affective disorders, 25, 261-269.

Tondo, L., Baldessarini, R.J., Hennen, J., et al. (1998) Lithium treatment and risk of suicidal behaviour in bipolar disorder patients. Journal of Clinical Psychiatry, 59, 405-414.