ANTISUICIDAL EFFECT OF LITHIUM AT INFRATHERAPEUTIC DOSE, A CASE REPORT

Abstract

An anti-suicide effect has been well documented in prolonged lithium treatments, with high-quality evidence in bipolar disorder and unipolar depression, shown to be significantly superior to other mood stabilizers, with a 50-80% of reduction in suicide risk.

We illustrate the case of a 70-year-old man who was admitted to our unit for attempted suicide by hanging after discontinuation of lithium treatment due to the detection of renal damage. Clinical stability had been maintained since the onset of the disease with a dose of 1200 mg/d, which was then reduced to 600 mg/d, obtaining maintained infratherapeutic levels of lithium of 0.32-0.34 mEq/L, psychopathological stability persisting for several more years.

Subsequently, progressive lithium withdrawal was performed over a 6-month period, which conveys depressive decompensation with delusion of harm approximately one month after complete withdrawal, without any improvement under antidepressant and antipsychotic treatments, culminating in attempted suicide aforementioned.

Notwithstanding an evident mood stabilizing and anti-suicide effects, and the fact that one third of the patients with bipolar disorder are considered excellent responders to lithium monotherapy, with complete remission of affective relapses, its use has declined in different countries for the last decades in favor of other drugs with a mood stabilizing effect.

Nevertheless, lithium is effective and safe in general. By performing adequate controls, its benefits often outweigh the risks. Overall, it is recommended to maintain it even in patients with a partial affective response, especially before a high suicide risk.