Zusammenfassung
Das Minireview fasst die derzeit vorhandene Evidenz aus nationalen und internationalen Beobachtungsstudien und randomisierten klinischen Studien zum suizidpräventiven Effekt von Lithiumsalzen im Vergleich zu anderen Stimmungsstabilisierern und Antidepressiva zusammen. Es handelt sich um ein Literaturreview ohne nach vorgegebenen Kriterien systematisierte Literatursuche. Ergebnisse Aus einer großen Zahl von Studien und Metaanalysen ergibt sich eine zunehmende und sehr valide Evidenz, dass eine adäquate Lithiumlangzeitmedikation das Suizidrisiko und die bei affektiven Störungen zwei- bis dreifach erhöhte Gesamtsterblichkeit markant senkt. Dieser Effekt wird bei Patienten mit allen Arten affektiver Störungen beobachtet. Eine vergleichbare Evidenz existiert nicht im Hinblick auf andere Stimmungsstabilisierer, z. B. Carbamazepin, Valproat oder atypische Neuroleptika oder für Antidepressiva. Fazit Die derzeit existierende Evidenz zur suizidpräventiven Wirksamkeit von Lithiumsalzen muss in adäquater Weise in Therapieleitlinien integriert und in der psychiatrischen Patientenversorgung berücksichtigt werden.
Abstract
Objective This minireview summarizes the existing evidence from large, international observational studies and RCTs on the suicide preventive effects of lithium as compared to other mood stabilizers and antidepressants. Methods Unsystematic literature review. Results There is increasing and robust evidence from a relatively large number of studies and metaanalyses that lithium long-term treatment reduces the suicide risk and overall mortality in patients with all kinds of depressive disorders (unipolar, bipolar, schizoaffective). Comparable evidence does not exist with regard to other mood stabilizers including atypical neuroleptics, or antidepressants. Conclusions The existing evidence on the suicide preventive effect of lithium should be integrated in therapeutic guidelines and routine psychiatric care.
Schlüsselwörter
Lithium - Suizid - Prävention - Antidepressiva
Key words
lithium - suicide - prevention - mood stabilizer - antidepressant
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Prof. Dr. med. Bruno Müller-Oerlinghausen
International Group for the Studies of Lithium-treated Patients (IGSLI)
Bartningallee 11 - 13
10557 Berlin
Email: bmoe@zedat.fu-berlin.de
