Regional Clozapine, ECT and Lithium Usage Inversely Associated with Excess Suicide Rates in Male Adolescents

Overview

Journal Nat Commun

Specialty Biology

Date 2023 Mar 15

PMID 36918566

Authors

Adrian E Desai Bostrom

Peter Andersson

Mathias Rask-Andersen

Hakan Jarbin

Johan Lundberg

Jussi Jokinen

Affiliations

Soon will be listed here.

Abstract

Advanced psychiatric treatments remain uncertain in preventing suicide among adolescents. Across the 21 Swedish regions, using nationwide registers between 2016-2020, we found negative correlation between adolescent excess suicide mortality (AESM) and regional frequencies of clozapine, ECT, and lithium (CEL) usage among adolescents (β = -0.613, p = 0.0003, 95% CI: -0.338, -0.889) and males (β = -0.404, p = 0.009, 95% CI: -0.130, -0.678). No correlation was found among females (p = 0.197). Highest CEL usage among male adolescents was seen in regions with lowest quartile (Q1) AESM (W = 74, p = 0.012). Regional CEL treatment frequency in 15-19-year-olds was related to lower AESM in males, reflecting potential treatment efficacy, treatment compliance or better-quality mental health care. Suicide prevention may benefit from early recognition and CEL treatment for severe mental illness in male adolescents. The results indicate association but further research, using independent samples and both prospective and observational methodologies, is needed to confirm causality.

Citing Articles

Scoping review on prevention of suicidal thoughts and behaviors in adolescents: methods, effectiveness and future directions.

Aoun J, Spodenkiewicz M, Marimoutou C Front Child Adolesc Psychiatry. 2025; 3:1367075.

PMID: 39839316 PMC: 11748894. DOI: 10.3389/frcha.2024.1367075.

Evaluating the adverse drug reactions to clozapine in populations of children and adolescents: insights from VigiBase data.

De Las Cuevas C, Sanz E, Jimenez-Fernandez S, Schoretsanitis G, Ruan C, De Leon J Eur Child Adolesc Psychiatry. 2024; .

PMID: 39621136 DOI: 10.1007/s00787-024-02623-3.

Efficacy and Safety of Lithium for Suicide and Suicide-Related Behaviors in Youth: A Review of the Literature.

Sesso G, Bargnesi F, Olzi F, Mutti G, Berloffa S, Viglione V Brain Sci. 2024; 14(11).

PMID: 39595902 PMC: 11592384. DOI: 10.3390/brainsci14111139.

Extended-Release Lithium Treatment for Adolescents with Bipolar Disorder with or Without Comorbid Autism Spectrum Disorder: Protocol of a Longitudinal Prospective Naturalistic Study for the Assessment of Efficacy and Tolerability.

Sesso G, Bargnesi F, Mutti G, Berloffa S, Viglione V, Fantozzi P J Clin Med. 2024; 13(20).

PMID: 39458145 PMC: 11508904. DOI: 10.3390/jcm13206196.

Prevention of suicidal behavior with lithium treatment in patients with recurrent mood disorders.

Tondo L, Baldessarini R Int J Bipolar Disord. 2024; 12(1):6.

PMID: 38460088 PMC: 10924823. DOI: 10.1186/s40345-024-00326-x.

References

Fazel S, Runeson B . Suicide. N Engl J Med. 2020; 382(3):266-274. PMC: 7116087. DOI: 10.1056/NEJMra1902944. View

Brent D . Master Clinician Review: Saving Holden Caulfield: Suicide Prevention in Children and Adolescents. J Am Acad Child Adolesc Psychiatry. 2018; 58(1):25-35. DOI: 10.1016/j.jaac.2018.05.030. View

Gorelick D, Vyas G . Suicide. N Engl J Med. 2020; 382(21):e66. DOI: 10.1056/NEJMc2002190. View

Ghaziuddin N, Shamseddeen W, Gettys G, Ghaziuddin M . Electroconvulsive Therapy for the Treatment of Severe Mood Disorders During Adolescence: A Retrospective Chart Review. J Child Adolesc Psychopharmacol. 2020; 30(4):235-243. DOI: 10.1089/cap.2019.0054. View

Wasserman D, Hoven C, Wasserman C, Wall M, Eisenberg R, Hadlaczky G . School-based suicide prevention programmes: the SEYLE cluster-randomised, controlled trial. Lancet. 2015; 385(9977):1536-44. DOI: 10.1016/S0140-6736(14)61213-7. View

Mann J, Michel C, Auerbach R . Improving Suicide Prevention Through Evidence-Based Strategies: A Systematic Review. Am J Psychiatry. 2021; 178(7):611-624. PMC: 9092896. DOI: 10.1176/appi.ajp.2020.20060864. View

Meltzer H, Alphs L, Green A, Altamura A, Anand R, Bertoldi A . Clozapine treatment for suicidality in schizophrenia: International Suicide Prevention Trial (InterSePT). Arch Gen Psychiatry. 2003; 60(1):82-91. DOI: 10.1001/archpsyc.60.1.82. View

Kaster T, Blumberger D, Gomes T, Sutradhar R, Wijeysundera D, Vigod S . Risk of suicide death following electroconvulsive therapy treatment for depression: a propensity score-weighted, retrospective cohort study in Canada. Lancet Psychiatry. 2022; 9(6):435-446. DOI: 10.1016/S2215-0366(22)00077-3. View

Asarnow J, Mehlum L . Practitioner Review: Treatment for suicidal and self-harming adolescents - advances in suicide prevention care. J Child Psychol Psychiatry. 2019; 60(10):1046-1054. PMC: 6880954. DOI: 10.1111/jcpp.13130. View

10.

Bridge J, Goldstein T, Brent D . Adolescent suicide and suicidal behavior. J Child Psychol Psychiatry. 2006; 47(3-4):372-94. DOI: 10.1111/j.1469-7610.2006.01615.x. View

11.

Cipriani A, Hawton K, Stockton S, Geddes J . Lithium in the prevention of suicide in mood disorders: updated systematic review and meta-analysis. BMJ. 2013; 346:f3646. DOI: 10.1136/bmj.f3646. View

12.

Gibbons R, Hur K, Bhaumik D, Mann J . The relationship between antidepressant prescription rates and rate of early adolescent suicide. Am J Psychiatry. 2006; 163(11):1898-904. DOI: 10.1176/ajp.2006.163.11.1898. View

13.

Shain B . Suicide and suicide attempts in adolescents. Pediatrics. 2007; 120(3):669-76. DOI: 10.1542/peds.2007-1908. View

14.

Armstrong R . When to use the Bonferroni correction. Ophthalmic Physiol Opt. 2014; 34(5):502-8. DOI: 10.1111/opo.12131. View

15.

de Berardis D, Fornaro M, Orsolini L, Ventriglio A, Vellante F, Di Giannantonio M . Emotional Dysregulation in Adolescents: Implications for the Development of Severe Psychiatric Disorders, Substance Abuse, and Suicidal Ideation and Behaviors. Brain Sci. 2020; 10(9). PMC: 7565002. DOI: 10.3390/brainsci10090591. View

16.

Naghavi M . Global, regional, and national burden of suicide mortality 1990 to 2016: systematic analysis for the Global Burden of Disease Study 2016. BMJ. 2019; 364:l94. PMC: 6598639. DOI: 10.1136/bmj.l94. View

17.

Hetrick S, McKenzie J, Bailey A, Sharma V, Moller C, Badcock P . New generation antidepressants for depression in children and adolescents: a network meta-analysis. Cochrane Database Syst Rev. 2021; 5:CD013674. PMC: 8143444. DOI: 10.1002/14651858.CD013674.pub2. View

18.

Hafeman D, Rooks B, Merranko J, Liao F, Gill M, Goldstein T . Lithium Versus Other Mood-Stabilizing Medications in a Longitudinal Study of Youth Diagnosed With Bipolar Disorder. J Am Acad Child Adolesc Psychiatry. 2019; 59(10):1146-1155. PMC: 6987013. DOI: 10.1016/j.jaac.2019.06.013. View

19.

Hubers A, Moaddine S, Peersmann S, Stijnen T, van Duijn E, van der Mast R . Suicidal ideation and subsequent completed suicide in both psychiatric and non-psychiatric populations: a meta-analysis. Epidemiol Psychiatr Sci. 2016; 27(2):186-198. PMC: 6998965. DOI: 10.1017/S2045796016001049. View

20.

Ho T, Gifuni A, Gotlib I . Psychobiological risk factors for suicidal thoughts and behaviors in adolescence: a consideration of the role of puberty. Mol Psychiatry. 2021; 27(1):606-623. PMC: 8960417. DOI: 10.1038/s41380-021-01171-5. View