The impact of lithium prophylaxis on mortality has been studied in 497 patients, 405
bipolars and 92 unipolars, who attended the same out-patient lithium clinic for up
to 30 years. In order to avoid preselection, no minimum period of lithium treatment
was required in our study. Of a total of 6014 patient-years, 4330 were spent in regular
contact with the study clinic. General mortality due to natural causes was not significantly
increased; among cardiovascular diseases, only pulmonary embolism showed an excess
mortality. No patients died of lithium intoxication or chronic renal insufficiency.
Patients were divided into three groups: Group A, 277 patients, attended the study
clinic until death or the end of the study, Group B, 86 patients, left the clinic
but continued to take lithium, and Group C, 134 patients, both left the clinic and
stopped taking lithium. Among bipolars, the suicide rate compared to the general population
was in excess in all three groups. Among unipolars, suicides occurred only after the
patients had left the study clinic and stopped taking lithium. A special analytical
method was used for intergroup comparisons of suicide rates. Bipolars in Group A attending
the study clinic regularly had a suicide rate of 3.5 per 1000 patient-years. The rate
increased to 6.3 or by 80 % if patients had left the clinic and did not take lithium
any longer as in Group C. The suicide rate in Group C increased by 45 % compared to
Group B, patients who left the clinic but continued to take lithium. Our results support
the hypothesis that lithium has a significant antisuicidal effect in bipolars as well
as in unipolars. The suicide mortality can be further reduced by regular attendance
in a specialised mood disorder clinic.
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