SUICIDAL-BEHAVIOR ON AND OFF LITHIUM PROPHYLAXIS IN A GROUP OF PATIENTS WITH PRIOR SUICIDE ATTEMPTS

One hundred patients who had attempted suicide before commencing lithi um prophylaxis were followed up. Outcome was analyzed in terms of atte mpted or completed suicide after a mean of 10 years since admission to the lithium clinics. Of 10 patients who committed suicide, 9 had disc ontinued adequate lithium prophylaxis for a period ranging hom 2 weeks to 7 years before death. Having discontinued Lithium therapy was asso ciated with suicide also in the subgroup of patients for whom lithium had not completely prevented episodes during lithium treatment. Suicid e risk was 24 times as high during periods off compared with periods o n adequate lithium prophylaxis. Incidence of attempting suicide was si milar during the periods before receiving or after discontinuing lithi um treatment, whereas it was 5 to 6 times lower during prophylaxis. Co ntinuous and adequate lithium prophylaxis should be considered in the presence of high suicide risk, even if the prophylactic effect on the underlying mood disorder may be incomplete.