Patients taking lithium had lower rates of self-harm and unintentional injury compared to those taking other bipolar drugs, such as valproate (Depacon, Depakote), olanzapine (Zyprexa) or quetiapine (Seroquel), said lead researcher Joseph Hayes. He is a fellow of psychiatry at University College London.”This is important because people with bipolar disorder are 15 times more likely to die by suicide and six times more likely to die by accidental injury than the general population,” Hayes explained.People taking one of the alternative mood stabilizers were 40 percent more likely to harm themselves compared to patients on lithium, Hayes and his colleagues found.
The researchers undertook their study following evidence reviews and studies that suggested lithium might be better than newer medications at preventing suicide and self-harm.These studies have contended that lithium achieves these results by reducing symptoms such as depression, aggression, risk-taking and impulsive behavior, according to background notes in the study.Lithium can be hard on the body, the study authors said, increasing a person’s risk of kidney and thyroid disease, but even that may have a positive side in bipolar patients. Because patients must be closely monitored for side effects, they are in more frequent contact with doctors who can pick up on emotional problems that lead to suicide, the researchers contend.
To compare lithium against newer medications, Hayes and his colleagues collected medical data on nearly 6,700 people diagnosed as bipolar and prescribed only one of the drugs — lithium, valproate, olanzapine or quetiapine.The investigators found that people on lithium were less likely to harm themselves, either intentionally or by accident.The suicide rate was lower in the lithium group, but too few suicides occurred to allow accurate risk estimates, the study authors said.
Lithium can cause kidney disease and hypothyroidism (underactive thyroid gland), Braga and Hayes said.Doctors need to carefully weigh benefits versus harm when prescribing lithium to people with kidney or thyroid problems, and “if these are severe, it should be avoided,” Hayes said. “Lithium [also] needs to be reviewed on an individual patient basis before pregnancy.”Braga said psychiatrists often require patients taking lithium to undergo lab tests every three to six months, to make sure their kidney function hasn’t been compromised.”Lithium is a great drug,” Braga said. “It’s definitely a drug every clinician should think about when prescribing for bipolar disorder.”