Lower suicide risk with long-term lithium treatment in major affective illness: a meta-analysis

Acta Psychiatr Scand. 2001 Sep;104(3):163-72. doi: 10.1034/j.1600-0447.2001.00464.x.


Objective: To compare suicide rates with vs. without long-term lithium treatment in major affective disorders.

Method: Broad searching yielded 22 studies providing suicide rates during lithium maintenance; 13 also provide rates without such treatment. Study quality was scored, between-study variance tested, and suicide rates on vs. off lithium examined by meta-analyses using random-effects regression methods to model risk ratios.

Results: Among 5647 patients (33 473 patient-years of risk) in 22 studies, suicide was 82% less frequent during lithium-treatment (0.159 vs. 0.875 deaths/100 patient-years). The computed risk-ratio in studies with rates on/off lithium was 8.85 (95% CI, 4.12-19.1; P<0.0001). Higher rates off-lithium were not accounted for by treatment-discontinuation.

Conclusion: Suicide risk was consistently lower during long-term treatment of major affective illnesses with lithium in all studies in the meta-analysis, including the few involving treatment-randomization.

Publication types

  • Meta-Analysis
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, Non-P.H.S.
  • Research Support, U.S. Gov't, P.H.S.
  • Review

MeSH terms

  • Adult
  • Bipolar Disorder / drug therapy*
  • Female
  • Humans
  • Lithium / therapeutic use*
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Odds Ratio
  • Retrospective Studies
  • Suicide / prevention & control*
  • Time Factors


  • Lithium