title: Opposite effects of suicidality and lithium on gray matter volumes in bipolar depression.
abstract: BACKGROUND
  Mood disorders are associated with the highest increase of attempted and completed suicide. Suicidality in major depressive disorder and in schizophrenia has been associated with reduced gray matter volumes in orbitofrontal cortex. Lithium reduces the suicide risk of patients with bipolar disorder (BD) to the same levels of the general population, and can increase GM volumes. We studied the effect of a positive history of attempted suicide and ongoing lithium treatment on regional GM volumes of patients affected by bipolar depression.
  
  
  METHODS
  With a correlational design, we studied 57 currently depressed inpatients with bipolar disorder: 19 with and 38 without a positive history of suicide attempts, 39 unmedicated and 18 with ongoing lithium treatment. Total and regional gray matter volumes were assessed using voxel-based morphometry.
  
  
  RESULTS
  Total GM volume is inversely correlated with depression severity. A positive history of suicide attempts was associated with higher stress in early life. Suicide attempters showed reduced GM volumes in several brain areas including dorsolateral prefrontal cortex, orbitofrontal cortex, anterior cingulate, superior temporal cortex, parieto-occipital cortex, and basal ganglia. Long term lithium treatment was associated with increased GM volumes in the same areas where suicide was associated with decreased GM.
  
  
  CONCLUSIONS
  Reduced GM volumes in critical cortical areas of suicidal patients could be a biological correlate of an impaired ability to associate choices and outcomes and to plan goal-directed behaviors based on a lifetime historical perspective, which, coupled with mood-congruent depressive cognitive distortions, could lead to more hopelessness and suicide. Lithium could exert its specific therapeutic effect on suicide by acting in the same areas.
authors.affiliation: Department of Clinical Neurosciences, Scientific Institute San Raffaele and University Vita-Salute, Milan, Italy. benedetti.francesco@hsr.it
authors.forename: Francesco
authors.initials: F
authors.lastname: Benedetti
authors.forename: Daniele
authors.initials: D
authors.lastname: Radaelli
authors.forename: Sara
authors.initials: S
authors.lastname: Poletti
authors.forename: Clara
authors.initials: C
authors.lastname: Locatelli
authors.forename: Andrea
authors.initials: A
authors.lastname: Falini
authors.forename: Cristina
authors.initials: C
authors.lastname: Colombo
authors.forename: Enrico
authors.initials: E
authors.lastname: Smeraldi
mesh_terms: D000328:Adult; D001714:Bipolar Disorder / Q000188:drug therapy* / Q000473:pathology* / Q000523:psychology; D016022:Case-Control Studies; D002540:Cerebral Cortex / Q000033:anatomy & histology / Q000187:drug effects / Q000473:pathology*; D003657:Decision Making; D003863:Depression; D003866:Depressive Disorder / Q000188:drug therapy / Q000523:psychology; D003865:Major Depressive Disorder / Q000188:drug therapy; D005260:Female; D006040:Goals; D006801:Humans; D018020:Lithium Compounds / Q000494:pharmacology / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D019964:Mood Disorders / Q000188:drug therapy; D009929:Organ Size; D017397:Prefrontal Cortex; D013405:Suicide; D013406:Suicide, Attempted / Q000523:psychology*
chemical_list: D018020:Lithium Compounds