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    Dr. G. re lithium
    ddnos posted:
    Hi Dr. G.

    I have read and I think that maybe you have mentioned that Lithium can reduce the risk of suicide for some people with mood disorders....

    This is great, but my question is 1) how on earth is that possible? and 2) how is something like that actually tested? I'm not questioning whether or not this is true, but am just curious what lithium does that it would potentially have such a life-saving effect for, from what I've read, a fairly high percentage of people with mood disorders who take the medication.

    Thank you

    Forgiveness is letting go of the hope that the past could have been any different --Unknown
    Joseph F Goldberg, MD responded:

    The studies describing an "antisuicide effect" with lithium track suicide attempts or completions in people on versus off lithium and tend to find about a 6-fold higher chance of attempting or completing suicide on lithium than off. There is also some research showing the same with Depakote (although not as many studies as with lithium). One study in Europe found that lithium reduced suicide attempts better than Tegretol did over several years, regardless of whether or not there were fewer mood episodes. It has been suggested that lithium may help to reduce suicidal behavior through its effects on serotonin, but that's just a theory. It's also been suggested that lithium may have this effect by reducing impulsiveness -- since lithium hasn't been shown to reduce suicidal thinking, just behavior, the idea is it may make people who feel suicidal less prone to act on the thoughts.

    Dr. G.
    ddnos replied to Joseph F Goldberg, MD's response:
    Dr. G.,

    You said,"and tend to find about a 6-fold higher chance of attempting or completing suicide on lithium than off." Did you mean to say "off lithium than on"? I hope so; otherwise, I'm confused. lol

    Thank you for the information!

    Forgiveness is letting go of the hope that the past could have been any different --Unknown
    hereinmyhead replied to Joseph F Goldberg, MD's response:
    Dr. G...another question, in the same vein as this one, so I didn't want to start a new thread for it. If I understand correctly, what it is you're trying to explain about the "lithium theory", than does that mean thinking has changed, or at least some heads have been turned (due to the research)?

    Because I have always been of the impression that the opposite was true - a higher chance of suicide attempt or completion - seen with long-term lithium use. (even in spite of the "Lithium Hysteria" I touch on briefly below).

    If ever a family existed that could in and of itself prove that "manic-depression" and bipolar disorders were genetic, it would be mine. With it, of course, there have been lots of suicides. Three of those, just in my generation, had all been on lithium. One of my favorite aunts believes to this day that it killed her son, my cousin, when he was 18. Li was no friend to my cousins/uncles/aunts/etc. Honestly, I only know perhaps 2-3 people who have had any success on LI at all (none at all before meeting them on this board).

    Do you have any thoughts or comments for the idea/suspicion that my family's real lithium nightmares, surrounded by the remaining family members and most friends who were entrenched in "Lithium Hysteria" might have more to do with the "nightmare vs hysteria" as arms of the same Monster: on-again, off-again compliance with a LI regimen?

    Talking to others here, who have said they never had any experiences remotely similar to what I've seen or known or was brought up to believe. My family's utter certainty that its the LI (and doctors) to blame in the end has always been extremely disturbing to me.

    Plus - the "staying on meds" part has forever been my own biggest healthcare sin. I'm terrible with any and all, not just the psych ones. I'm lucky if I manage a 5-day Z-pak without missing a dose by day 2, or just skipping the last 1 or 2 if I feel better sooner.

    Did I just answer my own question....sort of?
    hereinmyhead replied to ddnos's response:
    ddnos replied to hereinmyhead's response:
    Forgiveness is letting go of the hope that the past could have been any different --Unknown
    Joseph F Goldberg, MD replied to ddnos's response:
    Dear Debbie,

    Oops, my bad, you're right!

    Dr. G.
    Joseph F Goldberg, MD replied to hereinmyhead's response:
    Dear hereinmyhead,

    I'm sorry to hear of the bad experiences you describe regarding treatment. Lithium is a potentially lethal drug in overdose, and so if someone were quite intent on doing themself in and happened to have enough of a supply, they could indeed turn a life-saving drug into a lethal weapon. Barring such misuse, however, there are no data I know of to suggest that lithium increases risk of suicide, or for that matter, mortality. In fact, a large meta-analysis published in the American Journal of Psychiatry seversl years ago found that people with mood disorders who take lithium overall have a reduced risk of ALL CAUSE mortality as compared to those who don't take lithium. Speculation here is that if people with mood disorders experience greater and more sustained periods of stability they will take better care of their overall physical health (eg, better compliance with cardiac medicines, diabetes medicines, check-ups, less prone to accidents, etc.) Lithium works very well for a relatively small minority of people with bipolar disorder, and somewhat well for a somewhat larger segment...about half of people who take lithium don't experience a clear benefit. So (like with just about all medicines), if someone appears to have a lithium-responsive ailment, continuing to take it indefinitely and without interruption, and with proper medical monitoring (eg, kidney and thyroid tests) is probably more likely to lengthen the quantity and improve the quality of their life, rather than the reverse. Disrupted/choppy medication adherence (again as with most medicines) does lead to choppy results and iffier benefits.

    Dr. G.

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