Decreased risk of suicides and attempts during long-term lithium treatment: a meta-analytic review

Objectives: To update and extend comparisons of rates of suicides and suicide attempts among patients with major affective disorders with versus without long‐term lithium treatment. Methods: Broad searching yielded 45 studies providing rates of suicidal acts during lithium treatment, including 34 also providing rates without lithium treatment. We scored study quality, tested between‐study variance, and examined suicidal rates on versus off lithium by meta‐analytic methods to determine risk ratios (RRs) and 95% confidence intervals (CI). Results: In 31 studies suitable for meta‐analysis, involving a total of 85,229 person‐years of risk‐exposure, the overall risk of suicides and attempts was five times less among lithium‐treated subjects than among those not treated with lithium (RR = 4.91, 95% CI 3.82–6.31, p