Baldessarini R J, Tondo L, Hennen J
International Consortium for Research on Bipolar Disorders; the Department of Psychiatry, Harvard Medical School, Boston, Mass, USA.
J Clin Psychiatry. 1999;60 Suppl 2:77-84; discussion 111-6.
Whether mood-altering treatments reduce risk of suicidal behavior remains largely unproved.
We compared suicidal rates in published studies of patients treated with lithium with those who were not, and in a mood disorders clinic before, during, and after discontinuing lithium.
Published reports indicate a 7.0-fold lower rate of suicidal acts with lithium treatment of manic-depressive patients. In new findings in over 300 bipolar patients, latency from illness onset to lithium maintenance averaged 8.3 years (from 11.0 years in women with bipolar II disorder to 6.9 years in men with bipolar I disorder), but half of all suicidal acts occurred in the first 7.5 of 18.3 years at risk. Most acts (89%) occurred during depressive (73%) or dysphoric-mixed (16%) mood states and were associated with previous severe depression, prior attempts, and lower age at onset. Morbidity was reduced 2.7-fold and suicidal acts per year 6.5-fold during lithium treatment, with 8.3-fold cumulative sparing of risk by 15 years on lithium. In the first year off lithium, affective illness recurred in 67% of patients, and suicidal rates rose 20-fold but were much lower thereafter; fatalities were 14 times more frequent after discontinuation of lithium. Early morbidity was 2.5-fold lower, and suicidal risk was 2.0-fold lower after slow versus rapid discontinuation.
Lithium maintenance is associated with sustained reduction of suicidal acts in manic-depressive disorders. Treatment discontinuation, particularly abruptly, led to early affective morbidity and suicidal behavior. Improved diagnosis and treatment as well as earlier intervention for potentially lethal bipolar depression are urgently needed, as are studies of all mood-altering agents for effects on suicidal behavior.
改变情绪的治疗方法是否能降低自杀行为的风险在很大程度上仍未得到证实。
我们比较了已发表的锂盐治疗患者与未接受锂盐治疗患者的自杀率，并在一家情绪障碍诊所观察了停用锂盐前、期间和之后的情况。
已发表的报告表明，锂盐治疗躁郁症患者的自杀行为发生率降低了7.0倍。在对300多名双相情感障碍患者的新研究中，从疾病发作到开始锂盐维持治疗的平均间隔时间为8.3年（双相II型障碍女性为11.0年，双相I型障碍男性为6.9年），但在18.3年的风险期内，一半的自杀行为发生在最初的7.5年。大多数自杀行为（89%）发生在抑郁（73%）或烦躁混合（16%）情绪状态期间，且与既往严重抑郁、既往自杀未遂及发病年龄较低有关。在锂盐治疗期间，发病率降低了2.7倍，每年的自杀行为减少了6.5倍，到15年时累计风险降低了8.3倍。停用锂盐的第一年，67%的患者情感性疾病复发，自杀率上升了20倍，但此后大幅下降；停用锂盐后死亡频率增加了14倍。缓慢停用锂盐与快速停用相比，早期发病率降低了2.5倍，自杀风险降低了2.0倍。
锂盐维持治疗与躁郁症患者自杀行为的持续减少有关。停止治疗，尤其是突然停药，会导致早期情感性疾病和自杀行为。迫切需要改善诊断和治疗方法，以及对潜在致命的双相抑郁进行早期干预，同时也需要研究所有改变情绪的药物对自杀行为的影响。
