Tondo L, Jamison K R, Baldessarini R J
Department of Psychology, University of Cagliari, Sardinia, Italy.
Ann N Y Acad Sci. 1997 Dec 29;836:339-51. doi: 10.1111/j.1749-6632.1997.tb52369.x.
We reviewed evidence of a possible antisuicide action of lithium maintenance treatment in mood disorders. Of 28 published studies involving over 17,000 patients with major affective illnesses, most yielded supportive evidence: risk of suicides and attempts averaged 3.2 versus 0.37 per 100 patient-years without versus with lithium (8.6-fold difference). In a new study of 284 bipolar I- and II-disordered patients, corresponding rates (2.2 vs. 0.39/100 patient-years) differed by 5.6-fold (p < 0.001); moreover, after discontinuing lithium, rates of suicidal acts rose by 7-fold (16-fold within the first year), and fatalities increased by nearly 9-fold. Lithium maintenance treatment in recurring major mood disorders has strong evidence of antisuicide effects not demonstrated with any other mood stabilizer. Close association of suicide and depression in bipolar disorder emphasizes the need for improved identification and treatment of bipolar depression.
我们回顾了锂盐维持治疗在心境障碍中可能存在的抗自杀作用的证据。在28项涉及超过17000例重度情感性疾病患者的已发表研究中，大多数研究都提供了支持性证据：未使用锂盐与使用锂盐时，自杀及自杀未遂的风险分别为每100患者年3.2例和0.37例（相差8.6倍）。在一项针对284例双相I型和II型障碍患者的新研究中，相应的发生率（每100患者年2.2例与0.39例）相差5.6倍（p<0.001）；此外，停用锂盐后，自杀行为发生率上升了7倍（第一年上升了16倍），自杀死亡率增加了近9倍。在复发性重度心境障碍中，锂盐维持治疗具有明显的抗自杀作用，这是其他任何心境稳定剂所未证实的。双相情感障碍中自杀与抑郁的密切关联强调了改善双相抑郁的识别与治疗的必要性。
