To determine whether long-term lithium treatment was associated with reduction of suicidal risk in bipolar patients, the authors reviewed studies and previously reported data to quantify relationships of presence versus absence of lithium maintenace and suicides or suicide attempts in bipolar disorder patients. Results from 22 studies (1974-1998) yielded 7-fold lower suicidal rates for patients during long-term lithium treatment than for these patients when they were not receiving such treatment, patients lacking such treatment, or for patients after lithium discontinuation. (105 refs)