Sesso Gianluca, Bargnesi Francesca, Olzi Francesca, Mutti Giulia, Berloffa Stefano, Viglione Valentina, Fantozzi Pamela, Tolomei Greta, Guccione Fulvio, Milone Annarita, Masi Gabriele
IMT School for Advanced Studies, 55100 Lucca, Italy.
Developmental Psychiatry and Psychopharmacology, IRCCS Stella Maris Foundation, 56128 Pisa, Italy.
Brain Sci. 2024 Nov 13;14(11):1139. doi: 10.3390/brainsci14111139.
This systematic review evaluates the anti-suicidal properties of Lithium in children and adolescents with Bipolar Disorder (BD), addressing gaps in evidence regarding its efficacy and safety in reducing suicidality and self-harming behaviors.
A comprehensive literature search was conducted across PubMed, Web of Science, and Scopus up to February 2024. Eligible studies were those focusing on patients aged 25 years or younger, examining Lithium therapy and its impact on suicidal ideation and behaviors. The review included randomized controlled trials, longitudinal prospective and retrospective studies, and cross-sectional studies, while excluding expert opinions and case reports.
Evidence generally supports the efficacy of Lithium in reducing suicidal ideation and self-harming behaviors in youth with BD, though results are mixed. Randomized controlled trials demonstrated its effectiveness in mitigating suicidal thoughts during acute manic episodes, with effects persisting post-treatment. Longitudinal studies suggested that Lithium might offer superior outcomes compared to other mood stabilizers, although its specific impact on suicidality remains inconclusive. Cross-sectional studies and retrospective analyses reveal associations between Lithium use and reduced self-harming behaviors, but causality remains uncertain. While mood-stabilizing effects of Lithium offer potential benefits for reducing suicidality in youth, evidence on its direct impact on emotional dysregulation (ED) and long-term efficacy is limited. Variability in individual responses and adherence issues underscore the need for further research. Future studies should include larger, diverse samples, focus on ED symptoms, and explore Lithium mechanisms in suicidality prevention.
Lithium remains a promising treatment for mood stabilization and reduction in suicidality in youth with BD.
本系统评价评估了锂盐对双相情感障碍（BD）儿童和青少年的抗自杀特性，填补了其在降低自杀倾向和自伤行为方面的疗效和安全性证据空白。
截至2024年2月，在PubMed、科学网和Scopus上进行了全面的文献检索。符合条件的研究是那些关注25岁及以下患者，研究锂盐治疗及其对自杀意念和行为影响的研究。该评价纳入了随机对照试验、纵向前瞻性和回顾性研究以及横断面研究，同时排除了专家意见和病例报告。
证据总体上支持锂盐在降低BD青少年自杀意念和自伤行为方面的疗效，尽管结果不一。随机对照试验表明，锂盐在缓解急性躁狂发作期间的自杀想法方面有效，且治疗后效果持续存在。纵向研究表明，与其他心境稳定剂相比，锂盐可能会带来更好的结果，尽管其对自杀倾向的具体影响仍不确定。横断面研究和回顾性分析揭示了锂盐使用与自伤行为减少之间的关联，但因果关系仍不确定。虽然锂盐的心境稳定作用为降低青少年自杀倾向提供了潜在益处，但其对情绪失调（ED）的直接影响和长期疗效的证据有限。个体反应的变异性和依从性问题凸显了进一步研究的必要性。未来的研究应纳入更大、更多样化的样本，关注ED症状，并探索锂盐在预防自杀倾向中的机制。
锂盐仍然是一种有前景的治疗方法，可用于稳定BD青少年的情绪并降低其自杀倾向。
