RJB consults or engages in collaborative research with companies that produce medicines used to treat major psychiatric disorders (Eli Lilly & Co., IFI SpA, Janssen, JDS, Novartis). LT has served as a consultant to IFI SpA. MP has received research support from Eli Lilly & Co. JH had received grant or contract support from Eli Lilly & Co., JDS and Novartis. PD and JH received contract support from JDS Pharmaceuticals, a manufacturer of lithium products that helped in the preparation of an FDA petition on this topic. FKG has no reported conflict of interest. No author holds any equity positions in pharmaceutical corporations.
Decreased risk of suicides and attempts during long-term lithium treatment: a meta-analytic review
Article first published online: 17 OCT 2006
Volume 8, Issue 5p2, pages 625–639, October 2006
How to Cite
Baldessarini, R. J., Tondo, L., Davis, P., Pompili, M., Goodwin, F. K. and Hennen, J. (2006), Decreased risk of suicides and attempts during long-term lithium treatment: a meta-analytic review. Bipolar Disorders, 8: 625–639. doi: 10.1111/j.1399-5618.2006.00344.x
- Issue published online: 17 OCT 2006
- Article first published online: 17 OCT 2006
- Received 22 September 2005, revised and accepted for publication 13 March 2006
Vol. 9, Issue 3, 314, Article first published online: 5 APR 2007
- bipolar disorder;
- major affective disorders;
Objectives: To update and extend comparisons of rates of suicides and suicide attempts among patients with major affective disorders with versus without long-term lithium treatment.
Methods: Broad searching yielded 45 studies providing rates of suicidal acts during lithium treatment, including 34 also providing rates without lithium treatment. We scored study quality, tested between-study variance, and examined suicidal rates on versus off lithium by meta-analytic methods to determine risk ratios (RRs) and 95% confidence intervals (CI).
Results: In 31 studies suitable for meta-analysis, involving a total of 85,229 person-years of risk-exposure, the overall risk of suicides and attempts was five times less among lithium-treated subjects than among those not treated with lithium (RR = 4.91, 95% CI 3.82–6.31, p < 0.0001). Similar effects were found with other meta-analytic methods, as well as for completed versus attempted suicide, and for bipolar versus major mood disorder patients. Studies with higher quality ratings, including randomized, controlled trials, involved shorter exposures with somewhat lesser lithium superiority. Omitting one very large study or those involving lithium-discontinuation had little effect on the results. The incidence-ratio of attempts-to-suicides increased 2.5 times with lithium-treatment, indicating reduced lethality of suicidal acts. There was no indication of bias toward reporting positive findings, nor were outcomes significantly influenced by publication-year or study size.
Conclusions: Risks of completed and attempted suicide were consistently lower, by approximately 80%, during treatment of bipolar and other major affective disorder patients with lithium for an average of 18 months. These benefits were sustained in randomized as well as open clinical trials.