Long-term lithium treatment in the prevention of suicidal behavior in bipolar disorder patients
Long-term lithium treatment in the prevention of suicidal behavior in bipolar disorder patients
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DOI：
10.1017/s1121189x00000439
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发表时间：
2009-09
期刊：
影响因子：
--
通讯作者：
L. Tondo;R. Baldessarini
中科院分区：
文献类型：
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作者：
L. Tondo;R. Baldessarini
摘要我们回顾了现有的研究结果，包括锂治疗对双相或单相重度抑郁障碍患者自杀行为发生率影响的荟萃分析，以及锂与稳定情绪的抗惊厥药物的比较。荟萃分析的数据一致表明，在双相情感障碍患者的长期锂盐治疗期间，自杀行为和死亡率显著降低，单相、反复发作的重度抑郁患者也可能如此，也许比被认为是情绪稳定剂的抗惊厥药物更有效。自杀风险经常与烦躁不安的症状、愤怒、攻击性和冲动有关--所有这些都可能对锂或其他稳定情绪的药物比抗抑郁药物有更好的反应。在这种情况下，抗抑郁治疗可能不会对自杀念头或自杀企图的风险提供有益的影响，特别是在青少年中，而锂似乎在预防自杀行为方面似乎比抗惊厥药更有效。其作用机制尚未明确，可能与防止情绪复发或更具体的“抗自杀”活动有关。利益声明：Tondo博士得到了Janssen和Eli Lilly公司的研究支持，并曾担任葛兰素史克和默克公司的顾问。BALDESSARINI博士最近是以下公司的顾问或研究人员发起的研究合作者：阿斯利康、Auritec、Biotrofix、Janssen、JDS-Noven、礼来公司、Luitpold、NeuroHeating、诺华、辉瑞和SK-生物制药公司。提交人都不是医药发言人协会的成员，他们或任何家庭成员都不在生物医药或制药公司持有股权。
Abstract We reviewed available research findings, including meta-analyses on effects of lithium-treatment associated with rates of suicidal behavior in bipolar disorder or unipolar major depressive disorder patients, and for comparisons of lithium to mood-stabilizing anticonvulsants. Data from meta-analyses consistently indicate marked reductions of suicidal behavior and mortality during long-term treatment with lithium salts in bipolar disorder patients, and possibly also in unipolar, recurrent major depressive, perhaps even more effectively than with anticonvulsants proposed as mood-stabilizers. Suicidal risk is frequently associated with dysphoric-agitated symptoms, anger, aggression, and impulsivity-all of which may respond better to treatment with lithium or other mood-stabilizing medicines than to antidepressants. In these conditions, antidepressant treatment may not provide a beneficial effect on risk of suicidal thoughts and perhaps attempts, particularly in juveniles, whereas, lithium, perhaps even more than anticonvulsants, seems to be remarkably effective in the preventing suicidal behavior. The mechanism of action is not well defined and may be associated with either a prevention of mood recurrences or a more specific “antisuicidal” activity. Declaration of Interest: Dr. Tondo has received research support from Janssen and Eli Lilly Corporations and has served as a consultant to Glaxo-SmithKline and Merck Corporations. Dr. Baldessarini has recently been a consultant or investigator-initiated research collaborator with: AstraZeneca, Auritec, Biotrofix, Janssen, JDS-Noven, Lilly, Luitpold, NeuroHealing, Novartis, Pfizer, and SK-BioPharmaceutical Corporations. Neither author is a member of pharmaceutical speakers’ bureaus, nor do they or any family member hold equity positions in biomedical or pharmaceutical corporations.