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

Article type: Research Article

Authors: Börjesson, Joakim | Gøtzsche, Peter C.^{; *}

Affiliations: Institute for Scientific Freedom, Copenhagen, Denmark

Correspondence: [*] Address for correspondence: Peter C. Gøtzsche, Institute for Scientific Freedom, Copenhagen, Denmark. E-mail: pcg@scientificfreedom.dk.

Abstract: OBJECTIVE:To 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. DESIGN:Systematic review and meta-analysis. MAIN OUTCOME MEASURE:Total mortality. Secondary outcome was suicide. DATA SOURCES:PubMed 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. DATA EXTRACTION AND ANALYSIS:Two researchers extracted data independently. Data were analysed with Review Manager 5.3 (Peto odds ratio). RESULTS:We 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). CONCLUSION:According 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.

DOI: 10.3233/JRS-190058

Journal: International Journal of Risk & Safety in Medicine, vol. 30, no. 3, pp. 155-166, 2019