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Lithium in drinking water and suicide mortality

  • Nestor D. Kapusta (a1), Nilufar Mossaheb (a2), Elmar Etzersdorfer (a3), Gerald Hlavin (a4), Kenneth Thau (a5), Matthäus Willeit (a6), Nicole Praschak-Rieder (a6), Gernot Sonneck (a7) and Katharina Leithner-Dziubas (a8)...
Abstract
Background

There is some evidence that natural levels of lithium in drinking water may have a protective effect on suicide mortality.

Aims

To evaluate the association between local lithium levels in drinking water and suicide mortality at district level in Austria.

Method

A nationwide sample of 6460 lithium measurements was examined for association with suicide rates per 100 000 population and suicide standardised mortality ratios across all 99 Austrian districts. Multivariate regression models were adjusted for well-known socioeconomic factors known to influence suicide mortality in Austria (population density, per capita income, proportion of Roman Catholics, as well as the availability of mental health service providers). Sensitivity analyses and weighted least squares regression were used to challenge the robustness of the results.

Results

The overall suicide rate (R2 = 0.15, β =–0.39, t =–4.14, P = 0.000073) as well as the suicide mortality ratio (R2 = 0.17, β =–0.41, t =–4.38, P = 0.000030) were inversely associated with lithium levels in drinking water and remained significant after sensitivity analyses and adjustment for socioeconomic factors.

Conclusions

In replicating and extending previous results, this study provides strong evidence that geographic regions with higher natural lithium concentrations in drinking water are associated with lower suicide mortality rates.

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Copyright
Corresponding author
Nestor D. Kapusta, MD, Medical University of Vienna, Department for Psychoanalysis and Psychotherapy, Waehringer Guertel 18-20, A-1090 Vienna, Austria. Email: nestor.kapusta@meduniwien.ac.at
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Declaration of interest

None.

Footnotes
References
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1 Cade, JFJ. Lithium salts in the treatment of psychotic excitement. Med J Aust 1949; 2: 349–52.
2 Altamura, AC, Lietti, L, Dobrea, C, Benatti, B, Arici, C, Dell'osso, B. Mood stabilizers for patients with bipolar disorder: the state of the art. Expert Rev Neurother 2011; 11: 8599.
3 Müller-Oerlinghausen, B, Lewitzka, U. Lithium reduces pathological aggression and suicidality: a mini-review. Neuropsychobiology 2010; 62: 43–9.
4 Schrauzer, GN. Lithium: occurrence, dietary intakes, nutritional essentiality. J Am Coll Nutr 2002; 21: 1421
5 Concha, G, Broberg, K, Grandér, M, Cardozo, A, Palm, B, Vahter, M. High-level exposure to lithium, boron, cesium, and arsenic via drinking water in the Andes of northern Argentina. Environ Sci Technol 2010; 44: 6875–80.
6 Schrauzer, GN, de Vroey, E. Effects of nutritional lithium supplementation on mood. A placebo-controlled study with former drug users. Biol Trace Elem Res 1994; 40: 89101.
7 Schrauzer, GN, Shrestha, KP. Lithium in drinking water and the incidences of crimes, suicides, and arrests related to drug addictions. Biol Trace El Res 1990; 25: 105–13.
8 Ohgami, H, Terao, T, Shiotsuki, I, Ishii, N, Iwata, N. Lithium levels in drinking water and risk of suicide. Br J Psychiatry 2009; 194: 464–5.
9 Huthwaite, MA, Stanley, J. Lithium in drinking water (correspondence). Br J Psychiatry 2010; 196: 159; author reply 160.
10 Chandra, PS, Babu, GN. Lithium in drinking water and food, and risk of suicide (correspondence). Br J Psychiatry 2009; 195: 271; author reply 271–2.
11 Kapusta, ND, Posch, M, Niederkrotenthaler, T, Fischer-Kern, M, Etzersdorfer, E, Sonneck, G. Availability of mental health service providers and suicide rates in Austria: a nationwide study. Psychiatr Serv 2010; 61: 1198–203.
12 ÖBIG. Psychotherapie, Klinische Psychologie, Gesundheitspsychologie: Entwicklungsstatistik 1991–2005 [Psychotherapy, Clinical Psychology, Health Psychology: Development Statistics 1991–2005]. ÖBIG, 2006.
13 Kreienbrock, L, Schach, S. Epidemiologische Methoden (4th edn) [Epidemiological Methods]. Spektrum, 2005.
14 Stefánsson, A, Gunnarsson, I, Giroud, N. New methods for the direct determination of dissolved inorganic, organic and total carbon in natural waters by reagent-free ion chromatography and inductively coupled plasma atomic emission spectrometry. Anal Chim Acta 2007; 582: 6974.
15 Krachler, M, Shotyk, W. Trace and ultratrace metals in bottled waters: survey of sources worldwide and comparison with refillable metal bottles. Sci Total Environ 2009; 407: 1089–96.
16 Desai, G, Chaturvedi, SK. Lithium in drinking water and food, and risk of suicide (correspondence). Br J Psychiatry 2009; 195: 271; author reply 271–2.
17 Sparsa, A, Bonnetblanc, JM. Lithium. Ann Dermatol Venereol 2004; 131: 255–61.
18 Dawson, EP, Moore, TD, McGanity, WJ. Relationship of lithium metabolism to mental hospital admission and homicide. Dis Nerv Syst 1972; 33: 546–56.
19 Soares, JC, Boada, F, Spencer, S, Mallinger, AG, Dippold, CS, Wells, KF, et al. Brain lithium concentrations in bipolar disorder patients: preliminary (7)Li magnetic resonance studies at 3 T. Biol Psychiatry 2001; 49: 437–43.
20 Price, LH, Heninger, GR. Lithium in the treatment of mood disorders. N Engl J Med 1994; 331: 591–8.
21 Jermain, DM, Crismon, ML, Martin, ES 3rd. Population pharmacokinetics of lithium. Clin Pharm 1991; 10: 376–81.
22 Kampf, S, Tyler, S, Ortiz, C, Muñoz, JF, Adkins, P. Evaporation and land surface energy budget at the Salar de Atacama. Northern Chile. J Hydrology 2005; 310: 236–52.
23 Doessel, DP, Williams, RFG. The economics argument for a policy of suicide prevention. Suicidology Online 2010; 1: 6675.
24 Terao, T, Goto, S, Inagaki, M, Okamoto, Y. Even very low but sustained lithium intake can prevent suicide in the general population? Med Hypotheses 2009; 73: 811–2.
25 Gentile, S. Neurodevelopmental effects of prenatal exposure to psychotropic medications. Depress Anxiety 2010; 27: 675–86.
26 Hughes, JH, Dunne, F, Young, AH. Effects of acute tryptophan depletion on mood and suicidal ideation in bipolar patients symptomatically stable on lithium. Br J Psychiatry 2000; 177: 447–51.
27 Wada, A. Lithium and neuropsychiatric therapeutics: neuroplasticity via glycogen synthase kinase-3beta, beta-catenin, and neurotrophin cascades. J Pharmacol Sci 2009; 110: 1428.
28 Dawson, EP, Moore, TD, McGanity, WJ. The mathematical relationship of drinking water lithium and rainfall on mental hospital admission. Dis Nerv Syst 1970; 31: 110.
29 Voors, AW. Does lithium depletion cause atherosclerotic heart-disease? Lancet 1969; 2: 1337–9.
30 Voors, AW. Lithium content of drinking water and ischemic heart disease. N Engl J Med 1969; 281: 1132–3.
31 Young, AH. Invited commentary on … lithium levels in drinking water and risk of suicide. Br J Psychiatry 2009; 194: 466.
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Lithium in drinking water and suicide mortality

  • Nestor D. Kapusta (a1), Nilufar Mossaheb (a2), Elmar Etzersdorfer (a3), Gerald Hlavin (a4), Kenneth Thau (a5), Matthäus Willeit (a6), Nicole Praschak-Rieder (a6), Gernot Sonneck (a7) and Katharina Leithner-Dziubas (a8)...
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eLetters

Lithium in drinking water and suicide mortality in Austria

Takeshi Terao, Professor
16 May 2011

Congratulations to Kapusta et al (1) for having completed their greatwork. They performed a nationwide study across all 99 Austrian districts and showed that suicide mortality was inversely associated with lithium levels in drinking water after adjustment for socioeconomic factors. The scale and quality of their study is definitely beyond our study (2). As Kapusta et al (1) pointed out, however, regional lithium concentrations accounted for small part of the suicide mortality variance (17% in the crude model and 3.9% in the adjusted and weighted model). Nonetheless, their study has clearly and successfully demonstrated the inverse association between lithium levels in drinking water and suicide mortality.

Of course, as Kapusta et al (1) mentioned, lithium intake is not only from drinking water but also from various foods, bathing, showering and so on. Therefore, serum and/or urine lithium levels which are considered to contain any lithium intake should be measured in the residents to confirm the negative association with suicide mortality. Veryrecently, in Northern Argentina, Broberg et al (3) showed that urine lithium of the residents was inversely associated with plasma free thyroxine and positively associated with thyroid-stimulating hormone, although they did not investigate the association with suicide mortality. This finding suggests that exposure to lithium via drinking water may lower thyroid function. Taking other risks together into consideration, asKapusta et al (1) stated, it is highly controversial question whether adding lithium to tap water would be useful or not. It is necessary for usto further investigate and discuss whether and how very small amount of lithium may be administered for suicide prevention.

Finally, lithium may exert its antisuicidal effect via bothreinforcing top-down brakes (from the orbital frontal cortex to limbic system) and decreasing bottom-up drive (from limbic system to the orbital frontal cortex)(4). It seems likely that this antisuicidal effect is independent of mood-stabilizing effect of lithium because the mood-stabilizing effect usually requires 0.4 -1.0 mEq/L whereas the antisuicidal effect requires much below the range. Further studies are required to investigate the mechanism of this important antisuicidal effect of lithium.

References 1. Kapusta ND, Mossaheb N, Etzersdorfer E, Hlavin G, Thau K, Willeit M, Praschak-Rieder N, Sonneck G, Leithner-Dziubas K. Lithium in drinking water and suicide mortality. Br J Psychiatry 2011: 198: 346-350. 2. Ohgami H, Terao T, Shiotsuki I, Ishii N,Iwata N. Lithium levels in drinking water and risk of suicide. Br J Psychiatry 2011: 194: 464-465. 3. Broberg K, Concha G, Engstrom K, Lindvall M, Grander M, Vahter M. Lithium in drinking water and thyroid function. Environ Health Pers (doi: 10.1289/ehp.1002678, online 20 January2011) 4. Terao T. Agression, suicide, and lithium treatment. Am J Psychiatry 2008: 165: 1356-1357.
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