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.

Relationship Between Antiepileptic Drugs and Suicide Attempts in Patients With Bipolar Disorder

The objective of this study was to determine if antiepileptic drugs increase the risk of suicide attempt in patients with bipolar disorder. The study included a cohort of 47,918 patients with bipolar disorder with a minimum 1-year window of information before & after the index date of their illness. Overall, there was no significant difference […]

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 […]

Pharmacotherapy: Lithium and ALS, Levodopa and Neuropathy, Antiepileptic Drugs and Suicide

This article discusses recently published research in other journals including a study on suicide-related events in patients treated with antiepileptic drugs. The study found that current use of antiepileptic drugs was not associated with an increased risk of suicidal behaviours among patients with epilepsy but did increase risk among patients who received these drugs & […]

Lithium Levels in Drinking Water and Risk of Suicide


Invited Commentary on… Lithium Levels in Drinking Water and Risk of Suicide


Pharmacotherapy and Risk of Suicidal Behaviors Among Patients With Bipolar Disorder

Letters are from Bowden & Fawcett and Yerevanian, Koek, & Feusner.

Reduced Suicidal Ideation in Bipolar I Disorder Mixed-Episode Patients in a Placebo-Controlled Trial of Olanzapine Combined With Lithium or Divalproex

Symptoms associated with suicidality in bipolar I patients were identified & suicide risk during treatment with olanzapine in combination with lithium or divalproex was assessed. Data were used from a previous study in which patients with bipolar I manic or mixed-episode who were partially responsive to at least 2 weeks of lithium or divalproex monotherapy […]

Suicide in Depression With Special Reference to Antidepressant-Therapy

This presentation discussed the role of depression in suicidal behaviours & the consequent importance of therapeutic treatment for depression. The treatment of insomnia in patients with depression & the promise of lithium in suicide prevention was also discussed.

Reducing Suicide Risk in Psychiatric Disorders

Suicide is the leading cause of malpractice liability in psychiatry & of the heightened risk of death in persons with major affective & psychotic disorders. This article provides the latest findings to help clinicians choose medications for at-risk patients with bipolar disorder, major depression, or chronic psychoses. (25 refs.)