Lithium in the prevention of suicide in mood disorders: updated systematic review
and meta-analysis.
Author(s): Cipriani A(1), Hawton K, Stockton S, Geddes JR.
Affiliation(s): Author information:
(1)Department of Public Health and Community Medicine, Section of Psychiatry,
University of Verona, Verona, Italy. andrea.cipriani@psych.ox.ac.uk
Publication date & source: 2013, BMJ. , 346:f3646
OBJECTIVE: To assess whether lithium has a specific preventive effect for suicide
and self harm in people with unipolar and bipolar mood disorders.
DESIGN: Systematic review and meta-analysis.
DATA SOURCES: Medline, Embase, CINAHL, PsycINFO, CENTRAL, web based clinical
trial registries, major textbooks, authors of important papers and other experts
in the discipline, and websites of pharmaceutical companies that manufacture
lithium or the comparator drugs (up to January 2013).
INCLUSION CRITERIA: Randomised controlled trials comparing lithium with placebo
or active drugs in long term treatment for mood disorders.
REVIEW METHODS: Two reviewers assessed studies for inclusion and risk of bias and
extracted data. The main outcomes were the number of people who completed
suicide, engaged in deliberate self harm, and died from any cause.
RESULTS: 48 randomised controlled trials (6674 participants, 15 comparisons) were
included. Lithium was more effective than placebo in reducing the number of
suicides (odds ratio 0.13, 95% confidence interval 0.03 to 0.66) and deaths from
any cause (0.38, 0.15 to 0.95). No clear benefits were observed for lithium
compared with placebo in preventing deliberate self harm (0.60, 0.27 to 1.32). In
unipolar depression, lithium was associated with a reduced risk of suicide (0.36,
0.13 to 0.98) and also the number of total deaths (0.13, 0.02 to 0.76) compared
with placebo. When lithium was compared with each active individual treatment a
statistically significant difference was found only with carbamazepine for
deliberate self harm. Lithium tended to be generally better than the other active
comparators, with small statistical variation between the results.
CONCLUSIONS: Lithium is an effective treatment for reducing the risk of suicide
in people with mood disorders. Lithium may exert its antisuicidal effects by
reducing relapse of mood disorder, but additional mechanisms should also be
considered because there is some evidence that lithium decreases aggression and
possibly impulsivity, which might be another mechanism mediating the antisuicidal
effect.
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