Effect of lithium on suicide and mortality in mood disorders: A systematic review.

Abstract

OBJECTIVE\nTo assess if lithium treatment in patients with mood disorders, for instance depression, bipolar disorders and schizoaffective disorders has an effect on total mortality and suicide.\n\n\nDESIGN\nSystematic review and meta-analysis.\n\n\nMAIN OUTCOME MEASURE\nTotal mortality. Secondary outcome was suicide.\n\n\nDATA SOURCES\nPubMed and ClinicalTrials.gov. Eligible trials were randomized double-blind trials comparing lithium with placebo in patients with mood disorders who were not already on lithium before randomization in order to avoid withdrawal effects in the placebo group.\n\n\nDATA EXTRACTION AND ANALYSIS\nTwo researchers extracted data independently. Data were analysed with Review Manager 5.3 (Peto odds ratio).\n\n\nRESULTS\nWe found 45 eligible studies. Only four studies reported any suicides or other deaths in the lithium or placebo group. There was a significant reduction in total mortality (two versus nine), odds ratio 0.28 (95% confidence interval 0.08 to 0.93). There was no statistically significant reduction in suicides, (none versus three), odds ratio 0.13 (0.01 to 1.27).\n\n\nCONCLUSION\nAccording to our study, lithium reduces total mortality in mood disorders but not suicide. Because of small numbers and unreliable data, the findings should be interpreted with caution.