Sixteen-year mortality in patients with affective disorder commenced on lithium

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Abstract
Background: Lithium treatment is claimed to reduce mortality in patients with affective disorder, but the evidence is conflicting.Aim: To estimate mortality rates from a cohort of patients with affective disorder commenced on lithium with an observation period of two years and a follow-up after 16 years.Method: The mortality rates of patients were compared with those of the general Danish population, standardised for age, gender and calendar time with respect to death from all causes, suicide and death from cardiovascular disease.Results: Forty of the study's 133 patients died during the 16-year observation period (11 from suicide). Mortality among patients commenced on lithium was twice that of the general population. The statistically significantly elevated mortality was due largely to an excess of suicides; mortality from all other causes was similar to the background populations. Thirty-two patients died after the first two years of observation and were included in the analysis of the association between death and treatment compliance. Suicide occurred more frequently among those patients not complying with treatment.Conclusion: Mortality, especially suicide, was significantly increased in unselected patients with affective disorder commenced on lithium relative to the general population.