Mortality in 497 patients with affective disorders attending a lithium clinic or after having left it

The impact of lithium prophylaxis on mortality has been studied in 497 pati ents, 405 bipolars and 92 unipolars, who attended the same out-patient lith ium clinic for up to 30 years. In order to avoid preselection, no minimum p eriod of lithium treatment was required in our study. Of a total of 6014 pa tient-years, 4330 were spent in regular contact with the study clinic. Gene ral mortality due to natural causes was not significantly increased; among cardiovascular diseases, only pulmonary embolism showed an excess mortality . No patients died of lithium intoxication or chronic renal insufficiency. Patients were divided into three groups: Group A, 277 patients, attended th e study clinic until death or the end of the study, Group B, 86 patients, l eft the clinic but continued to take lithium, and Group C, 134 patients, bo th left the clinic and stopped taking lithium. Among bipolars, the suicide rate compared to the general population was in excess in all three groups. Among unipolars, suicides occurred only after the patients had left the stu dy clinic and stopped taking lithium, A special analytical method was used for intergroup comparisons of suicide rates. Bipolars in Group A attending the study clinic regularly had a suicide rate of 3.5 per 1000 patient-years . The rate increased to 6.3 or by 80% if patients had left the clinic and d id not take lithium any longer as in Group C. The suicide rate in Group C i ncreased by 45% compared to Group B, patients who left the clinic but conti nued to take lithium. Our results support the hypothesis that lithium has a significant antisuicidal effect in bipolars as well as in unipolars. The s uicide mortality can be further reduced by regular attendance in a speciali sed mood disorder clinic.