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- Title
Lithium Treatment in the Prevention of Repeat Suicide-Related Outcomes in Veterans With Major Depression or Bipolar Disorder: A Randomized Clinical Trial.
- Authors
Katz, Ira R.; Rogers, Malcolm P.; Lew, Robert; Thwin, Soe Soe; Doros, Gheorghe; Ahearn, Eileen; Ostacher, Michael J.; DeLisi, Lynn E.; Smith, Eric G.; Ringer, Robert J.; Ferguson, Ryan; Hoffman, Brian; Kaufman, James S.; Paik, Julie M.; Conrad, Chester H.; Holmberg, Erika F.; Boney, Tamara Y.; Huang, Grant D.; Liang, Matthew H.; Li+ plus Investigators
- Abstract
<bold>Importance: </bold>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.<bold>Objective: </bold>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.<bold>Design, Setting, and Participants: </bold>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.<bold>Interventions: </bold>Participants were randomized to receive extended-release lithium carbonate beginning at 600 mg/d or placebo.<bold>Main Outcomes and Measures: </bold>Time to the first repeated suicide-related event, including suicide attempts, interrupted attempts, hospitalizations specifically to prevent suicide, and deaths from suicide.<bold>Results: </bold>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.<bold>Conclusions and Relevance: </bold>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.<bold>Trial Registration: </bold>ClinicalTrials.gov Identifier: NCT01928446.
- Subjects
UNITED States. Dept. of Veterans Affairs; THERAPEUTIC use of lithium; CLINICAL trials; BIPOLAR disorder; MENTAL depression; MENTAL health services; SUICIDAL behavior; PSYCHOLOGY of veterans; SUICIDAL ideation; RANDOMIZED controlled trials; BLIND experiment; RESEARCH funding; VETERANS; STATISTICAL sampling; LITHIUM; ANTIPSYCHOTIC agents; TRANQUILIZING drugs; PHARMACODYNAMICS; DISEASE complications; PSYCHOSOCIAL factors
- Publication
JAMA Psychiatry, 2022, Vol 79, Issue 1, p24
- ISSN
2168-622X
- Publication type
journal article
- DOI
10.1001/jamapsychiatry.2021.3170