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. 2022 Nov 17;8(6):e199.
doi: 10.1192/bjo.2022.605.

Lithium in the prevention of suicide in adults: systematic review and meta-analysis of clinical trials

Natalie B Riblet  1 , Brian Shiner  2 , Yinong Young-Xu  1 , Bradley V Watts  3
Affiliations

Lithium in the prevention of suicide in adults: systematic review and meta-analysis of clinical trials

Natalie B Riblet et al. BJPsych Open. .

Abstract

Controversy exists regarding the efficacy of lithium for suicide prevention. Except for a recent trial that enrolled over 500 patients, available trials of lithium for suicide prevention have involved small samples. It is challenging to measure suicide in a single randomised controlled trial (RCT). Adding a single large study to existing meta-analyses may provide insights into lithium's anti-suicidal effects. We performed a meta-analysis of RCTs comparing lithium with a control condition for suicide prevention. MEDLINE and other databases were searched up to 30 November 2021. Efficacy was assessed by calculating the summary Peto odds ratio (OR) and incidence rate ratio (IRR) with 95% confidence intervals. Among seven RCTs, the odds of suicide were lower among patients receiving lithium versus control (OR = 0.30, 95% CI 0.09-1.02; IRR = 0.22, 95% CI 0.05-1.05), although the findings were still not statistically significant. The role of lithium in suicide prevention remains uncertain.

Keywords: Lithium; anti-manic agents; randomised controlled trials; suicide prevention; systematic review.

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Figures

Fig. 1
Fig. 1
Forest plot of the odds of suicide among patients randomised to lithium versus a control condition. a. References for the seven studies appear in the supplementary Methods. b. Participants with bipolar affective disorder had a mean lithium concentration of 0.54 mEq/L at 3 months, whereas those with major depressive disorder had a mean concentration of 0.46 mEq/L at 3 months. c. 11 patients had therapeutic levels and 29 patients had non-therapeutic levels of lithium. ER, extended release; n, number of suicide events; N, number of participants; Md, median, Mn, mean; NR, not reported; χ2, Cochran's Q.
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