Impact of lithium on mortality among older adults with major psychiatric disorders: A 5-year prospective multicenter study

Abstract

Objective

Prior studies report conflicting results about the association between lithium use and all-cause mortality. In addition, data are scarce on this association among older adults with psychiatric disorders. In this report, we sought to examine the associations of lithium use with all-cause mortality and specific causes of death (i.e., due to cardiovascular disorder, non-cardiovascular disease, accident, or suicide) among older adults with psychiatric disorders during a 5-year follow-up period.

Methods

In this observational epidemiological study, we used data from 561 patients belonging to a Cohort of individuals with Schizophrenia or Affective disorders aged 55-years or more (CSA). Patients taking lithium at baseline were first compared to patients not taking lithium, and then to patients taking (i) antiepileptics and (ii) atypical antipsychotics in sensitivity analyses. Analyses were adjusted for socio-demographic (e.g., age, gender), clinical characteristics (e.g., psychiatric diagnosis, cognitive functioning), and other psychotropic medications (e.g. benzodiazepines).

Results

There was no significant association between lithium use and all-cause mortality [AOR=1.12; 95%CI=0.45-2.79; p=0.810] or disease-related mortality [AOR=1.37; 95%CI=0.51-3.65; p=0.530]. None of the 44 patients taking lithium died from suicide, whereas 4.0% (N=16) of patients not receiving lithium did.

Conclusion

These findings suggest that lithium may not be associated with all-cause or disease-related mortality and might be associated with reduced risk of suicide in this population. They argue against the underuse of lithium as compared with antiepileptics and atypical antipsychotics among older adults with mood disorders.

Keywords:

• Lithium
• mortality
• elderly
• suicide
• antiepileptic
• antipsychotic

Acknowledgements

This study was supported by a grant from the French Ministry of Health and Social Affairs (PHRC 2008-N11-01) (http://solidarites-sante.gouv.fr/). It was promoted by the University of Reims Champagne-Ardenne (http://www.univ-reims.fr/) and the University Paris-Descartes (https://www.univ-paris5.fr/). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. We thank the Clinical Research Unit of Georges Pompidou European Hospital, and the Clinical Research Unit of Robert Debré Hospital. We warmly thank all the patients and the investigators who made this study possible.

Disclosure statement

All authors report no conflicts of interest related to the content of this article.

Author contributions

EL, FL and NH designed the study. FL obtained the funding. EL, MS-R, MA and NH undertook statistical analyses. EL, MS-R and NH wrote the first draft of the manuscript. CB, SY, EC and FL critically reviewed the manuscript. All authors contributed to and have approved the final manuscript.

Disclaimer

The views and opinions expressed in this report are those of the authors and should not be construed to represent the views of any of the sponsoring organizations, agencies, or the US government.

Additional information

Funding

The author(s) reported there is no funding associated with the work featured in this article.