Countering the declining use of lithium therapy: A call to arms

For over half a century, it has been widely known that lithium is the most efficacious treatment for bipolar disorder. Yet, despite this, its prescription has consistently declined over this same period of time. A number of reasons for this apparent disparity between evidence and clinical practice have been proposed, including a lack of confidence […]

Suicidal behavior in mood disorders: Response to pharmacological treatment

Suicidal behavior is strongly associated with depression, especially if accompanied by behavioral activation, dysphoria, or agitation. It may respond to some treatments, but the design of scientifically sound, ethical trials to test for therapeutic effects on suicidal behavior is highly challenging. In bipolar disorder, and possibly also unipolar major depression, an underprescribed medical intervention with […]

Association between the mood stabilizing treatment of bipolar disorder and risk of suicide attempts: A self-controlled case series study

Bipolar disorder (BPD) is associated with high rates of suicide attempts but the anti-suicidal effect of mood stabilizing agents remains unclear. This study aimed to examine the association between mood stabilizing agents (lithium, valproate, lamotrigine, carbamazepine or antipsychotics) and risk of suicide attempts in patients with BPD using self-controlled case series study design. Among 14,087 […]

How to save a life: From neurobiological underpinnings to psychopharmacotherapies in the prevention of suicide

The impact of suicide on our societies, mental healthcare, and public health is beyond questionable. Every year approximately 700 000 lives are lost due to suicide around the world (WHO, 2021); more people die by suicide than by homicide and war. Although suicide is a key issue and reducing suicide mortality is a global imperative, […]

Regional clozapine, ECT and lithium usage inversely associated with excess suicide rates in male adolescents

Advanced psychiatric treatments remain uncertain in preventing suicide among adolescents. Across the 21 Swedish regions, using nationwide registers between 2016–2020, we found negative correlation between adolescent excess suicide mortality (AESM) and regional frequencies of clozapine, ECT, and lithium (CEL) usage among adolescents (β = −0.613, p = 0.0003, 95% CI: −0.338, −0.889) and males (β = −0.404, p = 0.009, 95% CI: −0.130, −0.678). No […]

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

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 […]

Naturally absorbed lithium may prevent suicide attempts and deliberate self-harm while eicosapentaenoic acid may prevent deliberate self-harm and arachidonic acid may be a risk factor for deliberate self-harm: The updated different findings in new analyses

Background: Since our previous investigation on the effects of trace lithium, eicosapentaenoic acid (EPA), docosahexaenoic acid (DHA), and arachidonic acid (AA) on deliberate self-harm and suicide attempts in 2018, to our knowledge, no replication study has been conducted on this topic. Subjects and methods: We increased 37 new patients and totally 234 patients were re-analyzed to further […]

Mood stabilizers and risk of all-cause, natural, and suicide mortality in bipolar disorder: A nationwide cohort study

Objectives People with bipolar disorder have an elevated risk of mortality. This study evaluated associations between the use of mood stabilizers and the risks of all-cause mortality, suicide, and natural mortality in a national cohort of people with bipolar disorder. Methods In this nationwide cohort study, we used data from January 1, 2000, to December […]

Effects of lithium on suicide and suicidal behaviour: A systematic review and meta-analysis of randomised trials

Aims: Lithium has long been believed to reduce the risk of suicide and suicidal behaviour in people with mood disorders. Previous meta-analyses appeared to support this belief, but excluded relevant data due to the difficulty of conducting meta-analysis of rare events. The current study is an updated systematic review and meta-analysis that includes all eligible […]

Lithium treatment of bipolar disorder in adults: A systematic review of randomized trials and meta-analyses

The aim of the study was to systematically review the hard evidence alone, concerning lithium efficacy separately for the phases and clinical facets of Bipolar disorder (BD). The PRISMA method was followed to search the MEDLINE for Randomized Controlled trials, Post-hoc analyses and Meta-analyses and review papers up to August 1st 2020, with the combination […]

Lithium treatment in the prevention of repeat suicide-related outcomes in veterans with major depression or bipolar disorder: A randomized clinical trial

Objective: To assess whether lithium augmentation of usual care reduces the rate of repeated episodes of suicide-related events (repeated suicide attempts, interrupted attempts, hospitalizations to prevent suicide, and deaths from suicide) in participants with bipolar disorder or depression who have survived a recent event. Design, setting, and participants: This double-blind, placebo-controlled randomized clinical trial assessed lithium vs […]

Regional lithium prescription rates and recurrence in bipolar disorder

Background Lithium is the best documented maintenance treatment in bipolar disorder, but its use varies considerably across and within countries. It is not known whether regional differences in lithium prescription rates translate to differing regional outcomes. Aims To estimate associations between county specific lithium prescription rates and county specific recurrence odds of bipolar disorder in […]

Relationship between lithium levels in drinking water and suicide rates: A nationwide study in Lithuania

To investigate an association of lithium levels in the drinking water with suicide mortality rates in Lithuania. Methods: Samples from public drinking water systems were taken in all districts of Lithuania. Lithium levels were determined using the ion chromatography method. For the statistical calculations, lithium levels were averaged per district municipality and plotted against suicide […]

The association between lithium in drinking water and incidence of suicide across 15 Alabama counties

Background: Recent studies have shown that lithium may be effective at reducing suicide at low doses, such as those found in drinking water. Aims: The purpose of this study was to compare suicide rates with natural lithium levels in the drinking water of various Alabama counties. Method: Five drinking water samples from each of 15 […]

Is lithium a micronutrient? From biological activity and epidemiological observation to food fortification

Lithium compounds have been widely used in psychopharmacology, particularly in the treatment of bipolar disorder. Their normothymic and neuroprotective properties when used at high doses have been well established. However, a number of observations suggest that environmentally relevant lithium doses may also exert beneficial health effects, leading to a decrease in the rate of suicides […]

Suicidal behavior during lithium and valproate treatment: A within-individual 8-year prospective study of 50,000 patients with bipolar disorder.

Objective: Conclusions regarding lithium’s antisuicidal effect for bipolar disorder have been limited due to nonrepresentative subjects and potential confounding factors, including varying severity of illness. Findings regarding the effect of valproate, the most common alternative to lithium, are inconsistent for suicidal behavior. This study investigated the associations of these two drugs with the risk of […]

Lithium in tap water and suicide mortality in Japan.

Lithium has been used as a mood-stabilizing drug in people with mood disorders. Previous studies have shown that natural levels of lithium in drinking water may protect against suicide. This study evaluated the association between lithium levels in tap water and the suicide standardized mortality ratio (SMR) in 40 municipalities of Aomori prefecture, which has […]

Lithium in drinking water and suicide prevention: A review of the evidence.

Suicide is a serious public health problem worldwide, and many nations are committed to developing prevention programmes to reduce the incidence of suicide. To date, several strategies have been proposed for suicide prevention, both at the population and at the individual level, some of which may be pharmacological. In particular, a substantial amount of data […]

Lithium in drinking water and suicide mortality.

There is some evidence that natural levels of lithium in drinking water may have a protective effect on suicide mortality. Aims To evaluate the association between local lithium levels in drinking water and suicide mortality at district level in Austria. Method A nationwide sample of 6460 lithium measurements was examined for association with suicide rates […]

The suicide prevention effect of lithium: More than 20 years of evidence–a narrative review.

The management and treatment of patients with suicidal behavior is one of the most challenging tasks for health-care professionals. Patients with affective disorders are at high risk for suicidal behavior, therefore, should be a target for prevention. Numerous international studies of lithium use have documented anti-suicidal effects since the 1970s. Despite the unambiguous evidence of […]

What role does (should) lithium play in suicide treatment/prevention?


Lithium in the prevention of suicide in mood disorders: Updated systematic review and meta-analysis.

To assess whether lithium has a specific preventive effect for suicide and self harm in people with unipolar and bipolar mood disorders.

Arguments for the Specificity of the Antisuicidal Effect of Lithium

Results from the International Group for the Study of Lithium-Treated Patients, covering 5,616 patient years, clearly showed that adequate long-term lithium treatment significantly reduced & even normalized the excess mortality of patients with affective disorders. A meta-analysis on 17,000 patients pooled from 28 studies showed that the rate of suicidal acts in 8.6 fold higher […]