Reduced Suicide Risk During Lithium Maintenance Treatment

Background: About 20% of deaths of bipolar disorder patients are suicides associated with depressive or mixed episodes. Long-term lithium treatment may be associated with reduction of suicidalrisk. Method: We reviewed studies and our previously reported data to quantify relationships of presence versus absence of lithium maintenance and suicides or suicide attempts in bipolar disorder patients.Results: Results from 22 studies (1974-1998) yielded 7-fold lower suicidal rates for patientsduring long-term lithium treatment than for these patients when they were not receiving such treatment,patients lacking such treatment, or for patients after lithium discontinuation. Conclusions: Protection against suicide with lithium is incomplete, but rates of suicides plus attempts during lithiumtreatment may approach general population base rates. Better protection against bipolar depression isessential for limiting suicidal risk; alternatives to lithium require further study for effects on suicidalbehavior.