Lithium prevents suicide in mood disorders, according to updated systematic review


Mood disorders include schizoaffective, dysthymia, rapid cycling, unipolar and bipolar disorders. People with mood disorders have a 30 times higher risk of suicide than the general population.

Recent Mental Elf blogs have summarised the data on suicide risk and bipolar disorder, and shown that one key treatment is lithium which appears to have a robust evidence base in the long term treatment of bipolar disorder.

A previous systematic review published in 2005 concluded that lithium was effective in reducing suicide (Cipriani et al, 2005). This review has now been updated and published in the BMJ.


The authors conducted a systematic review and meta-analysis attempting to find all studies published up to January 2013 via a number of databases (Medline, PreMedline, Embase, Cinahl, PsycINFO, LILACS & Cochrane).

People with mood disorders have a 30 times higher risk of suicide than the general population

People with mood disorders have a 30 times higher risk of suicide than the general population

The review included all randomised controlled trials (RCTs) of long-term treatment of mood disorders. Long term treatment was defined as more than 12 weeks.

Data on three outcome measures were extracted:

  • Suicide events
  • Deliberate self harm
  • All cause mortality


  • 48 trials were identified from the initial 1,491 hits; 16 more trials than the previous review
    • This included 6,674 participants; a 70% increase from the previous review
Lithium was more effective than placebo at reducing suicide and all cause mortality, but not self-harm

Lithium was more effective than placebo at reducing suicide and all cause mortality, but not self-harm

  • Lithium was more effective than placebo in reducing:
    • Suicide (OR 0.13, 95% CI 0.03 to 0.66)
    • All cause mortality (OR 0.38, CI 0.15 to 0.95)
  • The effect on deliberate self-harm was less clear
  • When lithium was compared with other active drugs, there were no significant differences for either suicide rates, all cause mortality or deliberate self-harm
  • In further analysis, lithium was significantly better than anticonvulsants for deliberate self-harm


The authors conclude:

Lithium was associated with a reduced risk of suicide when compared with placebo, and also a reduced risk deliberate self harm when compared with carbamazepine.

A new finding is that lithium reduces the risk of suicide and total deaths in people with unipolar and bipolar depressive disorder.


The authors reported a number of limitations of their review. Most importantly were the small sample sizes of the studies included; the nature of low frequency events such as suicide and death; those at most risk are often excluded from drug trials, all of which can influence the treatment effects identified.

Whilst there is evidence supporting the use of lithium, the exact mechanism of action is still unknown.  A number of theories have been suggested which include the reduction of relapse rates, specific anti-suicidal properties, but also reduced impulsivity association with taking lithium.

Whilst lithium appears to remain an effective treatment option there are known concerns about the long-term use of the drug and it’s impact on an individual’s physical health (see the NPSA website for further details of safer lithium therapy).

If you need help

If you need help and support now and you live in the UK or the Republic of Ireland, please call the Samaritans on 116 123.

If you live elsewhere, we recommend finding a local Crisis Centre on the IASP website.

We also highly recommend that you visit the Connecting with People: Staying Safe resource.


Cipriani A, Hawton K, Stockton S, Geddes JR. Lithium in the prevention of suicide in mood disorders: updated systematic review and meta-analysisBMJ 2013;346:f3646

Cipriani A, Pretty H, Hawton K, Geddes JR. Lithium in the prevention of suicidal behavior and all-cause mortality in patients with mood disorders: a systematic review of randomized trials. Am J Psychiatry. 2005 Oct;162(10):1805-19. [PubMed abstract]

Bipolar disorder: the management of bipolar disorder in adults, children and adolescents, in primary and secondary care (PDF). NICE clinical guideline 38, Jul 2006.

NPSA (National Patient Safety Agency) web page on Safer Lithium Therapy. Last accessed on 1 Oct 2013.

Share on Facebook Tweet this on Twitter Share on LinkedIn Share on Google+
Mark as read
Create a personal elf note about this blog
Profile photo of John Baker

John Baker

John Baker was appointed to Chair of Mental Health Nursing in 2015. John's research focuses on developing complex clinical and psychological interventions in mental health settings. He is particularly interested in i) acute/inpatient mental health services and clinical interventions; ii) medicines management in mental health care; iii) the attitudes and clinical skills of mental health workers, iv) the mental health workforce. The good practice manuals which he developed have been evaluated, cited as examples of good practice, and influenced clinical practice in the UK and abroad. The training package for patients, service users and carers to promote research awareness and understanding has been cited by the MHRN and NICE as an exemplar of good practice.

John is a member of the NIHR post-doctoral panel, sits on the Editorial boards for Journal of Psychiatric and Mental Health Nursing & International Journal of Mental Health Nursing. He is a Registered Nurse Teacher with the Nursing, Midwifery Council (NMC) and is active within Mental Health Nursing Academics (UK).

More posts

Follow me here –