Adjunctive lithium treatment in the prevention of suicidal behavior in patients with depression and comorbid personality disorders

Abstract

Objective. Patients with both major depression and personality disorders have a high risk of suicidal behavior. Lithium is meant to have anti-suicidal properties in patients with affective disorders. The anti-suicidal effect of lithium in patients with affective disorders and comorbid personality disorders has not been investigated yet. Methods. A post-hoc analysis of a subsample of patients with depression and comorbid personality disorder (PD) and a recent suicide attempt (n = 19) from the prospective, placebo-controlled lithium intervention study (N = 167), was conducted. Results. Three patients in the lithium group (n = 8) and two patients in the placebo group (n = 11) presented a suicide attempt throughout the course of the study. No differences related to suicidal behavior could be detected between the placebo group and the group with lithium intervention. Conclusions. On the basis of the small sample size, among patients with comorbid PD, lithium does not seem to have an effect on suicidal behavior in contrast to patients with affective disorders without comorbid PD.

Key words::

• Lithium
• suicide
• major depression
• affective disorders
• personality disorder

Acknowledgements

The authors wish to thank Robert O'Brien, who assisted in the proofreading of the manuscript, and Thorsten Meyer, Guenter Niklewski and Barabara Hawellek for their support in the study of Lauterbach et al.

Statement of interest

The placebo-controlled trial by Lauterbach et al. from 2008 was supported by grants 01GI 9920 and 01GI 0220 from the German Ministry for Education and Research, within the promotional emphasis German Research Network on Depression (subproject 1.2), and German Research Foundation grant LA 1975 / 2-1 to Erik Lauterbach. Additional funding was granted by Sanofi-Aventis. The funding agencies had no role in the design and conduct of the study: Neither collection, management, analysis and interpretation of the data, nor preparation, review or approval of the manuscript.

Dr. Mueller-Oerlinghausen is a member of the Drug Commission of the German Medical Association. Dr. Lewitzka received grants from the BMBF (Bundesministerium für Bildung und Forschung) and Dalhousie University, Halifax, Canada, and grants from Lundbeck and Astra Zeneca. All other authors declare no conflict of interest.