The efficacy of lithium in the treatment of suicidal ideation, behavior and suicide: An updated systematic review and meta-analysis of randomized controlled trials
Bibliographic record
Abstract
OBJECTIVES: Lithium is a first-line treatment for bipolar disorder, especially BD-I. In addition to efficacy in treating acute mania and recurrence prevention in bipolar disorder, lithium's anti-suicide effects have been documented in studies showing reduced rates of completed suicide and serious attempts. To update current knowledge on the topic, we conducted a systematic review and meta-analysis of lithium's impact in randomized controlled trials on suicidality (i.e., suicidal ideation, attempts, and suicide). METHODS: Herein we followed Cochrane protocols and PRISMA guidelines to search OVID databases (Embase, MedLine, PsychINFO) from January 2013 to July 2024 for randomized trials evaluating lithium's effect on suicidality, specifically reporting suicidal ideation, attempts, or related mortality outcomes. We identified earlier studies from manual reference searching. Two reviewers independently extracted data and assessed quality. RESULTS: From 1793 articles, 15 studies (eight placebo-controlled, n = 1698; seven open-label, n = 1338) met eligibility criteria. Lithium was associated with nonsignificant reductions in suicide attempts (OR = 0.73; 95 % CI = [0.41, 1.31]; 25 in the lithium cohort vs. 63 on placebo) and completed suicide (OR = 0.61; 95 % CI = [0.25, 1.48]; lithium 4 vs. 13 placebo). Heterogeneity in methods and measures used to quantify suicidal ideation prevented quantitative analysis. CONCLUSIONS: Methodological limitations affect assay sensitivity for suicidality measures, notably small sample sizes, diagnostic heterogeneity, inadequate treatment fidelity, subtherapeutic lithium levels, and intersubject differences in prior suicidality. Failure to reach statistical significance likely results from type II error, yet lithium's beneficial effects on suicide attempts and completed suicide align with observational studies.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.024 | 0.062 |
| Meta-epidemiology (narrow) | 0.003 | 0.002 |
| Meta-epidemiology (broad) | 0.024 | 0.033 |
| Bibliometrics | 0.011 | 0.010 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.004 | 0.003 |
| Open science | 0.003 | 0.002 |
| Research integrity | 0.003 | 0.002 |
| Insufficient payload (model declined to judge) | 0.005 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".