The efficacy of lithium in the treatment of suicidal ideation, behavior and suicide: An updated systematic review and meta-analysis of randomized controlled trials

IF 4.9 2区医学 Q1 CLINICAL NEUROLOGY

Journal of affective disorders Pub Date : 2025-05-27 DOI:10.1016/j.jad.2025.119487

James Xiaolong Wang , Gia Han Le , Sabrina Wong , Kayla M. Teopiz , Angela T.H. Kwan , Joshua D. Rosenblat , Taeho Greg Rhee , Roger Ho , Heidi Ka Ying Lo , Joseph F. Goldberg , Maj Vinberg , Iria Grande , Rodrigo Mansur , Jonathan M. Meyer , Roger S. McIntyre

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引用次数: 0

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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锂治疗自杀意念、行为和自杀的疗效：一项随机对照试验的最新系统综述和荟萃分析

目的锂离子是双相情感障碍，尤其是BD-I的一线治疗药物。除了治疗急性躁狂症和预防双相情感障碍复发的功效外，锂的抗自杀效果已经在研究中被证明可以降低自杀成功率和严重的自杀企图。为了更新关于该主题的现有知识，我们对锂在随机对照试验中对自杀（即自杀意念、企图和自杀）的影响进行了系统回顾和荟萃分析。方法在本文中，我们按照Cochrane协议和PRISMA指南检索OVID数据库（Embase, MedLine, PsychINFO），检索2013年1月至2024年7月评估锂对自杀影响的随机试验，特别是报告自杀意念、企图或相关死亡结果。我们从手工参考检索中确定了早期的研究。两名审稿人独立提取数据并评估质量。结果在1793篇文献中，15项研究(8项安慰剂对照，n = 1698；7例开放标签患者（n = 1338）符合入选标准。锂与自杀企图的无显著降低相关(OR = 0.73；95% ci = [0.41, 1.31]；锂盐组25例，安慰剂组63例)和完成自杀(OR = 0.61；95% ci = [0.25, 1.48]；锂4 vs安慰剂13)。量化自杀意念的方法和措施的异质性阻碍了定量分析。结论：方法学的局限性影响了自杀测量的灵敏度，特别是样本量小、诊断异质性、治疗保真度不足、亚治疗锂水平以及既往自杀倾向的受试者间差异。未能达到统计显著性可能是由于II型错误，然而锂对自杀未遂和完成自杀的有益影响与观察性研究一致。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of affective disorders 医学-精神病学

CiteScore

10.90

自引率

6.10%

发文量

1319

审稿时长

9.3 weeks

期刊介绍： The Journal of Affective Disorders publishes papers concerned with affective disorders in the widest sense: depression, mania, mood spectrum, emotions and personality, anxiety and stress. It is interdisciplinary and aims to bring together different approaches for a diverse readership. Top quality papers will be accepted dealing with any aspect of affective disorders, including neuroimaging, cognitive neurosciences, genetics, molecular biology, experimental and clinical neurosciences, pharmacology, neuroimmunoendocrinology, intervention and treatment trials.