Table 2.
Suicidal acts in 13 randomized controlled trials of lithium
| Trial | Diagnosis | Acts/subjects/years | Other treatment | RR (n/N/years) | |
|---|---|---|---|---|---|
| Lithium | Comparator | ||||
| 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)