K. Thies-Flechtner

Recent findings have indicated that lithium treatment markedly reduces suicide risk in major affective disorders. To compare the effect of lithium with carbamazepine and amitriptyline, suicidal behavior was analyzed during the randomized prospective long-term MAP study (N = 378; duration 2.5 years). Of the nine suicides and five attempted suicides, none took place during lithium treatment. The findings support the view that lithium has a specific antisuicidal effect over and above its prophylactic benefit.

There is strong evidence that platelet 5-HT uptake is reduced during depressive illness, yet it is an open question whether this abnormality can be reverted to normal by successful treatment. The effect of longterm lithium treatment (> 2 years of continuous therapy) on 5-HT uptake of 37 euthymic affective patients without relevant additional medication was investigated. There was no difference in 5-HT uptake kinetics between the whole group of patients and age- and sex-matched healthy controls. The subgroups of unipolar patients and patients with minor recurrences during prophylaxis tended to have lower Vmax values of 5-HT uptake. The results generally support the hypothesis of a relationship between successful lithium treatment and normalization of 5-HT uptake.