Prevention of suicidal behavior with lithium treatment in patients with recurrent mood disorders

International Journal of Bipolar Disorders

Table 2 Suicidal acts in 13 randomized controlled trials of lithium

Trial	Diagnosis	Acts/subjects/years		Other treatment	RR (n/N/years)
Trial	Diagnosis	Lithium	Comparator	Other treatment	RR (n/N/years)
Prien et al. 1973a	MAD	0/45/2.0	1/39/2.0	Pbo	> 1283
Prien et al. 1973b	BD	0/101/2.0	1/104/2.0	Pbo	> 481
Greil et al. 1997	BD	0/74/2.5	2/70/2.5	CBZ	> 1143
Kleindienst and Greil 2000	MAD	0/86/2.5	6/285/2.5	CBZ	> 842
Bowden et al. 2003	BD	0/46/1.5	1/129/1.5	LTG/Pbo	> 310
Calabrese et al. 2003	BD	0/121/1.5	2/242/1.5	LTG	?551
Tohen et al. 2005	BD	1/214/1.0	0/217/1.0	ONZ	< 1.0
Lauterbach et al. 2008	MAD	0/84/1.0	3/83/1.0	Pbo	> 3614
Geddes et al. 2010	BD	2/110/2.0	5/110/2.0	VPA	2.50
Licht et al. 2010	BD	1/78/1.0	1/77/2.5	LTG	1.01
Oquendo et al. 2011	BD	6/49/2.5	8/49/2.5	VPA	3.40
Weisler et al. 2011	BD	3/346/2.0	11/808/2.0	QTP/Pbo	1.96
Katz et al. 2022	BD	1/144/1.0	3/125/1.0	Pbo	3.46
Totals/mean years	–	14/1498/1.73	36/2338/1.73	–	–
Rate (%) [95% CI]	–	0.935 [0.512–1.56]	1.54 [1.08–2.13]	–	–
Rate/100 k PEY	–	540	810	–	1.65

Outcome is suicide or attempt in RCTs vs. placebo or an alternative mood-stabilizer with at least one suicidal act in one of the two arms as a numerator (n). BD bipolar disorder, CBZ carbamazepine, LTG lamotrigine, MAD, major affective disorders, ONZ, olanzapine, Pbo placebo, PEY person-exposure-years, QTP quetiapine, RR rate ratio (based on rates as n/N/years as per 100 k PEY); VPA valproate. Data with references are from recent reviews: Baldessarini et al. (2006); Cipriani et al. (2013); Lewitzka et al. (2015); Del Matto et al. (2020). Based on meta-analysis (Fig. 1), the pooled Odds Ratio (OR with 95% CI) was 0.491 [CI: 0.278–0.864] (z-score = 2.46, p = 0.01)