TY  - JOUR
PY  - 2021//
TI  - Lithium treatment in the prevention of repeat suicide-related outcomes in veterans with major depression or bipolar disorder: a randomized clinical trial
JO  - JAMA Psychiatry
A1  - Katz, Ira R.
A1  - Rogers, Malcolm P.
A1  - Lew, Robert
A1  - Thwin, Soe Soe
A1  - Doros, Gheorghe
A1  - Ahearn, Eileen
A1  - Ostacher, Michael J.
A1  - Delisi, Lynn E.
A1  - Smith, Eric G.
A1  - Ringer, Robert J.
A1  - Ferguson, Ryan
A1  - Hoffman, Brian
A1  - Kaufman, James S.
A1  - Paik, Julie M.
A1  - Conrad, Chester H.
A1  - Holmberg, Erika F.
A1  - Boney, Tamara Y.
A1  - Huang, Grant D.
A1  - Liang, Matthew H.
SP  - ePub
EP  - ePub
VL  - ePub
IS  - ePub
N2  - 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><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. 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. INTERVENTIONS: Participants were randomized to receive extended-release lithium carbonate beginning at 600 mg/d or placebo. 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><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><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. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT01928446.<p />  <p>Language: en</p>
LA  - en
SN  - 2168-622X
UR  - http://dx.doi.org/10.1001/jamapsychiatry.2021.3170
ID  - ref1
ER  -