Individuals with bipolar disorder who took lithium reported reduced suicidal ideation and fewer suicide attempts than bipolar patients not taking lithium, according to a study in the Journal of Clinical Psychiatry.Why It’s Relevant
Nearly one third of individuals with bipolar disorder attempt suicide, and individuals with this disorder have a 58-fold higher rate of dying by suicide compared with the general population. Existing evidence suggests lithium pharmacotherapy reduces suicide attempts and mortality in this population, but less attention has been paid to the key precursor of suicidal ideation.
By the Numbers
- Among 585 patients (ages 12 to 45 years) with bipolar disorder recruited from inpatient and outpatient settings across China, 59% reported past-year suicidal ideation and 24% reported at least one past-year suicide attempt.
- Past-year lithium use (338 days on average) was associated with a 43% lower risk of suicidal ideationand a 40% lower risk of suicidal behaviors (suicide preparations or attempts) after one year, compared with no past-year lithium use.
- Lithium’s anti-suicidal properties were more pronounced in females, adults, and higher-income individuals; lithium was also more protective in patients without comorbid anxiety, rapid cycling, or predominantly depressive episodes.
- The lithium group also reported lower hostility scores, but the medication didn’t impact non-suicidal self-injury.
What’s More
Lithium was associated with reduced suicidal ideation regardless of a patient’s history of psychotic symptoms—suggesting potential use even in severe bipolar cases.
The Other Side
While reducing suicidal ideation and behavior is a recommended strategy to reduce suicide risk in patients, it may not directly equate to a reduction in death by suicide, the researchers noted. The observational study design and nonrandom treatment allocation further limited causal inference.
Takeaway Message
“By demonstrating [lithium’s] comprehensive anti-suicidal benefits—from ideation to behavior—our results reaffirm lithium’s central place in maintenance therapy and offer timely insights for clinicians facing a global decline in lithium prescribing,” the researchers noted.
Related Information
Source
Ni Xu, et al. Association of lithium use with suicide and self-harm among Chinese adolescents and adults with bipolar disorder: a nationwide multicenter retrospective cohort study. Journal of Clinical Psychiatry. Published August 10, 2026. doi:10.4088/JCP.25m16219
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