Lithium mortality

Coppen et al. (191) evaluated the status of 104 bipolar or unipolar recurrent patients after 10 years of lithium maintenance to assess mortality rate, in part because of reports indicating unusually high rates, with many deaths attributed to suicide. Compliance was very high, with only 6% discontinuing lithium therapy, and patients also received adjunctive antipsychotic and/or antidepressants when clinically indicated. No patient died of suicide during this period, in contrast to the results in lithium noncompliant patients. The authors concluded that the absence of suicide resulted from the significant reduction in morbidity achieved by the careful administration of lithium. 

Finally, when given in large doses, lithium may increase the risk of fetal macrosomia, premature delivery, and perinatal mortality (based on unpublished data on 241 infants). 

Coppen A, Standish-Barry H, Bailey J, et al. Long-term lithium and mortality. Lancet 1990 335 1347. 

Recent follow-up studies focus on patients who comply with lithium for long periods, thereby selecting patients whose outcome is relatively benign. People who comply with any treatment, including placebo, are known to have better outcomes than non-compliers in a range of medical conditions, including even reduced mortality (Simpson et al. 2006). 

In two studies of 277 and 133 patients taking long-term lithium, there was no evidence of increased cardiovascular mortality compared with the general population (113,114). While the latter study reported on 16-year mortality, it did not provide information about which patients continued to take lithium after the first 2 years. 

However, in a systematic review there were significantly fewer deaths from all causes in lithium-treated patients (9 out of 696, 1.3%) compared with those who took other agents (22 out of 788, 2.8% OR = 0.42 95% Cl = 0.21, 0.87) (241). Individuals with bipolar illness have a doubled standardized mortality ratio compared with the general population (445). This difference appears to be due to factors such as frequent depressive episodes, co-morbidity with substance abuse, and lifestyle problems, such as reduced exercise, poor diet, and a lower... 

Kallner G, Lindelius R, Petterson U, Stockman O, Tham A. Mortality in 497 patients with affective disorders attending a lithium clinic or after having left it. Pharmacopsychiatry 2000 33(1) 8-13. 

Brodersen A, Licht RW, Vestergaard P, Olesen AV, Mortensen PB. Sixteen-year mortality in patients with affective disorder commenced on lithium. Br J Psychiatry 2000 176 429-33. 

Cipriani A, Pretty H, Hawton K, Geddes JR. Lithium in the prevention of suicidal behavior and all-cause mortality in patients with mood disorders a systematic review of randomized trials. Am J Psychiatry 2005 162(10) 1805-19. 

The first year after diagnosis can be an extremely difficult time for the patient and is often marked by treatment noncompliance and relapse. Thus patient education should include a discussion of the serious implications of medication noncompliance. Some individuals may naively (or out of denial) view periodic manic episodes as relatively benign occurrences, when in fact these are times of increased mortality risk. Patients should be informed that recurring manic episodes may increase susceptibility to future episodes. Additionally, some patients may actually become less responsive to lithium treatment with repeated episodes of mania. The therapist can be instrumental in helping patients recognize that continued medication noncompliance may actually contribute to a progressive worsening of their disorder. 

Dual-diagnosis treatment program substance abuse plus standard pharmacologic/ nonpharmacologic treatments for bipolar disorder hepatic dysfunction from chronic alcohol abuse or from hepatitis may alter the metabolism of some agents Lithium long-term treatment associated with reduction of suicide risk and mortality... 

I Lithium treatment reduces the standardised mortality rate to a level similar to the general population. 

Low lithium, decreased fertility, pre-and postnatal growth, and increased mortality... 

Helbich M, Leitner M, Kapusta ND. Geospatial examination of lithium in drinking water and suicide mortality. Int J Health Geogr 2012 11 19 (8 pages). 

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