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November 17, 2021

Testing for Antisuicidal Effects of Lithium Treatment

Author Affiliations
  • 1Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
  • 2The International Consortium for Mood & Psychotic Disorders Research, Mailman Research Center, McLean Hospital, Belmont, Massachusetts
  • 3Lucio Bini Mood Disorders Centers, Cagliari, Sardinia, and Rome, Italy
JAMA Psychiatry. Published online November 17, 2021. doi:10.1001/jamapsychiatry.2021.2992
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    2 Comments for this article
    Not 'antisuicidal'
    Carolyn Quadrio, MD | School of Psychiatry, University of New South Wales, NSW, Australia
    While i have no quarrel with the substance of this article, I take issue
    with the use of the term, 'antisuicidal'. Suicide is a complex behaviour
    that must be understood, at the very least, in terms of individual
    cognition, motivation, affect, and attachment relationships, and in terms of
    much broader philosophical and existential concerns. If it is proposed that
    a single chemical can reverse the outcome of this complex interaction, then
    a model must be presented for how that comes about. There does not seem to
    be such a model.

    The use of the 'anti' prefix has
    become standard in psychiatry but is in
    error. Psychiatry has fallen for the marketing ploys of the pharmaceutical
    industry, which developed the term anti-depressant to suggest the
    specificity and efficacy of anti-biotic. However, we know exactly how
    antibiotics work: they target and destroy or disable particular pathogens.
    There are laboratory tests that can demonstrate this. We have not identified
    any such process for antidepressants. The same can be said for
    antipsychotics. Far from having specific actions or uses, both
    antidepressants and antipsychotics have gradually become more widely and
    less specifically used, alarmingly so. Antibiotics continue to be used
    primarily for their designated purpose of attacking particular pathogens.

    Carolyn Quadrio
    Response to Carolyn Quadrio
    Andrew Tuck |
    I'm afraid I disagree with Carolyn Quadrio's comment here. The idea that our use of the prefix "anti" in psychiatry is pharmaceutical propaganda is far-fetched. So is the assertion that using "anti" in the name of a class of drugs implies that we fully understand the mechanisms of action of those drugs. There is nothing about that prefix that implies such a thing. The term "antibiotic" does not entail a specific mechanism of action either (e.g. peptidoglycan cross-linkage inhibition). "Anti" is a common prefix that is germane not only to virtually all branches of science, but even common parlance. It is not a fancy technical term. Further, we actually DO understand how antipsychotics work (all FDA-approved antipsychotics for schizophrenia block D2 receptors, and we even understand how this specifically produces an antipsychotic effect; we also know that 5HT2a blockade is common in these drugs and likely antipsychotic to some extent) and increasingly antidepressants.

    But again, the prefix "anti" is not some sort of ideology-laden jargon. It literally just means "against." Antidepressants have anti-depression properties, so we call them antidepressants. Antipsychotics have anti-psychosis properties, so we call them antipsychotics.

    And yes, if lithium has anti-suicidal effects, we will call these effects anti-suicidal.