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Review
. 2024 Mar 9;12(1):6.
doi: 10.1186/s40345-024-00326-x.

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

Leonardo Tondo  1   2   3 , Ross J Baldessarini  4   5
Affiliations
Review

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

Leonardo Tondo et al. Int J Bipolar Disord. .

Abstract

Suicidal behavior is more prevalent in bipolar disorders than in other psychiatric illnesses. In the last thirty years evidence has emerged to indicate that long-term treatment of bipolar disorder patients with lithium may reduce risk of suicide and attempts, with possibly similar benefits in recurrent major depressive disorder. We review and update selected research literature on effects of lithium treatment in reducing suicidal behavior and consider proposals that higher levels of lithium in drinking water may be associated with lower suicide rates. We summarize results of a growing number of randomized, controlled studies of lithium treatment for suicide prevention including comparisons with placebos or alternative treatments, and comment on the severe challenges of such trials. The basis of a proposed protective effect of lithium against suicidal behaviors remains uncertain but may include protective effects against recurrences of depressive phases of mood disorders, especially with mixed features or agitation, and possibly through beneficial effects on impulsivity, agitation and dysphoric mood.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Forest plot of meta-analysis of 13 randomized, controlled trials of rates of suicidal acts in patients with type I bipolar disorder (BD1), any bipolar disorder (BD), or mixed major mood disorders (MADs) treated with lithium versus placebo or alternative mood-stabilizing or antipsychotic agents (carbamazepine [CBZ], lamotrigine [LTG], olanzapine [ONZ], quetiapine [QTP], or valproate [VPA]). The pooled (black diamond) Odds Ratio (OR) is 0.491 [CI: 0.278–0.864], favoring lithium (z-score = 2.46, p = 0.01)
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