Older, Cheap Drug May Cut Suicide Risk for People With Mood Disorders

Review of data finds that lithium benefits people with depression, bipolar illnesses

By Robert Preidt

HealthDay Reporter

THURSDAY, June 27 (HealthDay News) -- A new review of data suggests than an old and inexpensive drug, lithium, may help lower suicide risk in people with mood disorders such as depression or bipolar disorder.

"The study provides further evidence that one of the most effective psychiatric medications for preventing suicide in patients with mood disorders is also one of our oldest," said one expert not connected to the research, Dr. Andrew Kolodny, chairman of psychiatry at Maimonides Medical Center in New York City.

According to background information from the researchers, people with mood disorders have a 30 times higher risk of suicide compared to the general population.

Treatment with mood-stabilizing drugs such as lithium, anticonvulsants or antipsychotics can help maintain mood within normal limits, but their role in suicide prevention has been unclear, according to background information in the review, which was published online June 27 in the journal BMJ.

The review was led by Andrea Cipriani, of the department of psychiatry at Oxford University in the United Kingdom. His team analyzed the results of 48 clinical trials involving more than 6,600 people.

The researchers found lithium to be linked with a 60 percent reduction in the risk of suicide and other causes of death compared with people who took a placebo.

They also found that lithium may reduce the risk of self-harm in people with mood disorders. "[The review] reinforces lithium as an effective agent to reduce the risk of suicide in people with mood disorders," the team said.

How the drug works to cut suicide risk remains unclear. Lithium may reduce relapses of mood disorders, but there also is "some evidence that lithium decreases aggression and possibly impulsivity, which might be another mechanism mediating the anti-suicidal effect," the researchers said.

The drug has many side effects, however, so the researchers said doctors "need to take a balanced view of the likely benefits and harm of lithium in the individual patient."

Dr. Robert Dicker, associate director of the Child/Adolescent Psychiatry Division at Zucker Hillside Hospital in Glen Oaks, N.Y., called the new study "a great reminder that lithium offers tremendous benefits in treating patients with mood disorders and suicide."

But Kolodny said the drug is not used as often as it could be. "Lithium, which is generic and not promoted by pharmaceutical companies, tends to be under-prescribed," he said. "Hopefully, this study will help change that."

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Migraine, Chronic Back Pain Tied to Higher Suicide Risk

Hopelessness, disability may play a role in feelings of despair, study finds

By Dennis Thompson

HealthDay Reporter

WEDNESDAY, May 22 (HealthDay News) -- People who endure chronic migraines or back pain are more likely to attempt suicide, whether or not they also suffer from depression or another psychiatric condition, according to a new study.

"Clinicians who are seeing patients with certain pain conditions should be aware they are at increased risk of suicide," said study co-author Mark Ilgen, of the Veterans Affairs Serious Mental Illness Treatment Resource and Evaluation Center in Ann Arbor, Mich.

"Although undoubtedly psychiatric factors are important, there might be aspects of the pain that in and of themselves increase a person's risk," Ilgen said. "There might be something about someone with significant pain that puts them at increased risk."

The wide-ranging study, published online May 22 in the journal JAMA Psychiatry, involved more than 4.8 million people who received care from the U.S. Veterans Health Administration during fiscal year 2005. Researchers identified those suffering from chronic pain and tracked them for the next three years to see if any died from suicide.

The research team then looked for associations between suicide death -- the 10th most common cause of death in the United States -- and clinical diagnoses of chronic pain conditions, such as arthritis, back pain, migraines, neuropathy, headaches or tension headaches, fibromyalgia and psychogenic pain.

They found that all pain conditions except arthritis and neuropathy were associated with elevated suicide risk. But when they took into account the mental-health problems that chronic pain patients also had, the associations reduced for all but three types of chronic pain: back pain, migraines and psychogenic pain, which stems from psychological factors.

Dr. Elspeth Cameron Ritchie, a retired Army colonel and psychiatrist living in Washington, D.C., said the study clearly reinforces the anecdotal link between pain and suicide.

"It makes sense that pain is a risk factor for suicide," she said. "Often, suicide has several different things going on, but pain can be the straw that breaks the camel's back in terms of a person's decision not to go on."

Therapists performing a suicide-risk evaluation should consider adding a question regarding pain to the standard questions aimed at suicidal thoughts and planning, she said.

"It's not a standard question: 'Are you in pain?'" Ritchie said. "I would ask, 'Are you in pain?,' or 'Is pain an issue for you?'"

Psychogenic pain increased people's risk of suicide the most, followed by migraines and back pain. Psychogenic pain is chronic pain caused or exacerbated by mental or emotional problems, and Ilgen said it is a rare and not well understood condition.

"We think that's not so much about psychogenic pain per se, but the fact that the pain itself is poorly understood and may be poorly managed," Ilgen said. "There's not a clear treatment plan for that type of pain. It's likely that patients with this type of pain may be frustrated with their care and more hopeless and more at risk for suicide."

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One in Every 12 Stroke Survivors Contemplates Suicide, Study Finds

Title: One in Every 12 Stroke Survivors Contemplates Suicide, Study Finds
Category: Health News
Created: 2/7/2013 2:36:00 PM
Last Editorial Review: 2/8/2013 12:00:00 AM

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