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Lithium for suicide and readmission prevention after electroconvulsive therapy for unipolar depression: population-based register study

  • Ole Brus (a1), Yang Cao (a2), Åsa Hammar (a3), Mikael Landén (a4), Johan Lundberg (a5), Pia Nordanskog (a6) and Axel Nordenskjöld (a7)...

Abstract

Background

Electroconvulsive therapy (ECT) is effective for unipolar depression but relapse and suicide are significant challenges. Lithium could potentially lower these risks, but is used only in a minority of patients.

Aims

This study quantifies the effect of lithium on risk of suicide and readmission and identifies factors that are associate with readmission and suicide.

Method

This population-based register study used data from the Swedish National Quality Register for ECT and other Swedish national registers. Patients who have received ECT for unipolar depression as in-patients between 2011 and 2016 were followed until death, readmission to hospital or the termination of the study at the end of 2016. Cox regression was used to estimate hazard ratios (HR) of readmission and suicide in adjusted models.

Results

Out of 7350 patients, 56 died by suicide and 4203 were readmitted. Lithium was prescribed to 638 (9%) patients. Mean follow-up was 1.4 years. Lithium was significantly associated with lower risk of suicide (P = 0.014) and readmission (HR 0.84 95% CI 0.75–0.93). The number needed to be treated with lithium to prevent one readmission was 16. In addition, the following factors were statistically associated with suicide: male gender, being a widow, substance use disorder and a history of suicide attempts. Readmission was associated with young age, being divorced or unemployed, comorbid anxiety disorder, nonpsychotic depression, more severe symptoms before ECT, no improvement with ECT, not receiving continuation ECT or antidepressants, usage of antipsychotics, anxiolytics or benzodiazepines, severity of medication resistance and number of previous admissions.

Conclusions

More patients could benefit from lithium treatment.

Declaration of interest

None.

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Copyright

This is an Open Access article, distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives licence (http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is unaltered and is properly cited. The written permission of Cambridge University Press must be obtained for commercial re-use or in order to create a derivative work.

Corresponding author

Correspondence: Ole Brus, Klinisk epidemiologi och biostatistik, X-huset, Universitetssjukhuset ÖREBRO, 701 85 Örebro, Sweden. Email: ole.brus@regionorebrolan.se

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Lithium for suicide and readmission prevention after electroconvulsive therapy for unipolar depression: population-based register study

  • Ole Brus (a1), Yang Cao (a2), Åsa Hammar (a3), Mikael Landén (a4), Johan Lundberg (a5), Pia Nordanskog (a6) and Axel Nordenskjöld (a7)...
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