Lithium and suicide in mood disorders: Updated meta-review of the scientific literature.

Journal article

Objectives

Suicide and suicidal behaviour is increased in mood disorders, particularly bipolar disorders. Observational studies and small randomised controlled studies (RCTs) support the idea that taking lithium is associated with a reduction in these rates. This paper aims to review the best evidence for the effect of lithium on rates of suicide and self harm.

Methods

We searched systematically for systematic reviews and meta-analyses of RCTs of lithium and suicide and self harm.

Results

A large number of reviews were identified, but only 16 publications were systematic reviews. Of these three systematic reviews of lithium and suicide rates and one of lithium and self harm confined only to RCTs were identified. Despite some methodological concerns, the evidence to date is overwhelmingly in favour of lithium as an antisuicidal agent, even balanced against any potential disadvantages of its use in regular clinical practice.

Conclusions

The results are discussed in the context of the difficulties in conducting studies in this area and the supporting evidence that observational studies and non-randomised studies can provide. Given this evidence, however, the use of lithium is still under-represented in clinical practice and should be incorporated more assertively into current guidelines.

Authors: Smith, K; Cipriani, A

• Publication status: Published
• Peer review status: Peer reviewed
• Publisher: Wiley
• Journal: Bipolar Disorders
• Volume: 19
• Issue: 7
• Pages: 575-586
• Publication date: 2017-09-12
• Acceptance date: 2017-07-24
• DOI: 10.1111/bdi.12543
• EISSN: 1399-5618
• ISSN: 1398-5647
• Pmid: 28895269
• Language: English
• Keywords: systematic review; unipolar depression; meta-analysis; mood disorders; suicide; bipolar disorder; randomized controlled trial; self harm; lithium