SynthesisEpidemiology and psychiatric sciences2022
Effects of lithium on suicide and suicidal behaviour: a systematic review and meta-analysis of randomised trials.
Synthesis in Epidemiology and psychiatric sciences, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 24 papers, 1 of them a synthesis that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
24 citing papers in PubMed, 1 synthesis or guideline pooled it, 54 citations in OpenAlex.
- A systematic review of the role of clozapine for severe borderline personality disorder.Psychopharmacology · 2023Pooled it
- No Evidence of Moderated Impulsivity Following Administration of the IMPase Inhibitor Ebselen in Healthy Adults.Human psychopharmacology · 2026Trial
- Association Between Lithium Use and Suicide-Related Behaviors in Bipolar Disorder: A Multicenter Study.Bipolar disorders · 2026Article
- Manifestations of Lithium Deficiency in the Human Body: What is Known to Date (A Narrative Review).Biological trace element research · 2026Review
- Lithium for the prevention of suicide in US veterans: a target trial emulation.BMJ mental health · 2026Article
- Effect of psychotropic medications on suicide-related outcomes: a systematic review and meta-analysis of observational studies.EClinicalMedicine · 2026Article
- New Episodes and Suicidal Risks in Bipolar and Major Depressive Disorder Patients During Versus Before Long-Term Treatment With Lithium.Acta psychiatrica Scandinavica · 2025Article
- Context, Timing and Individualized Care: A Realist Evaluation of Safety Planning for Individuals Living with Suicide-Related Thoughts and Behaviours, Their Families and Friends and Service Providers.Journal of clinical medicine · 2025Article
- History of Suicide Prevention with Lithium Treatment.Pharmaceuticals (Basel, Switzerland) · 2025Review
- Lithium in Drinking Water and its Potential Impact on Mental Health: A Review.Current medicinal chemistry · 2025Review
- Electroconvulsive therapy reduces suicidality and all-cause mortality in refractory depression: A systematic review and meta-analysis of neurostimulation studies.Neuroscience applied · 2025Review
- Efficacy and Safety of Lithium for Suicide and Suicide-Related Behaviors in Youth: A Review of the Literature.Brain sciences · 2024Review
- Trace Lithium for Suicide Prevention and Dementia Prevention: A Qualitative Review.Pharmaceuticals (Basel, Switzerland) · 2024Review
- Assessing suicidality in adult ADHD patients: prevalence and related factors : Suicidality in adult ADHD patients.Annals of general psychiatry · 2024Article
- Development of a Clinical Guideline for Suicide Prevention in Psychiatric Patients Based on the ADAPTE Methodology.Psychiatry investigation · 2024Article
- Mortality risk and mood stabilizers in bipolar disorder: a propensity-score-weighted population-based cohort study in 2002-2018.Epidemiology and psychiatric sciences · 2024Article
- New Advances in the Pharmacology and Toxicology of Lithium: A Neurobiologically Oriented Overview.Pharmacological reviews · 2024Review
- Real-world evidence from a retrospective study on suicide during depression: clinical characteristics, treatment patterns and disease burden.BMC psychiatry · 2024Article
- Prevention of suicidal behavior with lithium treatment in patients with recurrent mood disorders.International journal of bipolar disorders · 2024Review
- Country-specific psychopharmacological risk of reporting suicidality comparing 38 antidepressants and lithium from the FDA Adverse Event Reporting System, 2017-2023.Frontiers in psychiatry · 2024Article
Corrections and comments
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Authors and funding
5 authors at 2 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
aimsLithium 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 data, and evaluates suicide, non-fatal suicidal behaviour (including suicidal ideation) and suicide attempts.
methodsWe searched PubMed, PsycINFO and Embase and some trial registers. We included all randomised trials comparing lithium and placebo or treatment as usual in mood disorders published after 2000, to ensure suicide was reliably reported. Trial quality was assessed using the Cochrane Risk of Bias tool. Pooled data were analysed using Fisher's Exact test. In addition, meta-analysis was conducted using various methods, prioritizing the Exact method. All trials were included in the analysis of suicide initially, regardless of whether they reported on suicide or not. We conducted a sensitivity analysis with trials that specifically reported on suicides and one that included trials published before 2000. Pre-specified subgroup analyses were performed involving suicide prevention trials, trials excluding people already taking lithium, trials involving people with bipolar disorder exclusively and those involving people with mixed affective diagnoses. Non-fatal suicidal behaviour and suicide attempts were analysed using the same methods, but only trials that reported these outcomes were included. PROSPERO registration: CRD42021265809.
resultsTwelve eligible studies involving 2578 participants were included. The pooled suicide rate was 0.2% for people randomised to lithium and 0.4% with placebo or treatment as usual, which was not a statistically significant difference; odds ratio (OR) = 0.41 (95% confidence interval 0.03-2.49),
conclusionsEvidence from randomised trials is inconclusive and does not support the idea that lithium prevents suicide or suicidal behaviour.
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What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.