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Comment & Response
March 9, 2022

Suicide Risk and Lithium—Reply

Author Affiliations
  • 1Department of Psychiatry, Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania
  • 2Perelman School of Medicine, Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania
  • 3Boston Cooperative Studies Program Coordinating Center, VA Boston Healthcare System, Boston, Massachusetts
  • 4Department of Medicine, Boston University School of Medicine, Boston, Massachusetts
  • 5Section of Rheumatology, Inflammation and Immunity, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
  • 6Section of Rheumatology, Department of Medicine, VA Boston Healthcare System, Boston, Massachusetts
JAMA Psychiatry. 2022;79(5):513-514. doi:10.1001/jamapsychiatry.2022.0084

In Reply We appreciate the comments of Manchia and colleagues on our study1 on lithium treatment for prevention of repeated suicide-related outcomes in veterans with major depression or bipolar disorder. The study reported a nonsignificant hazard ratio for repeated suicide-related behaviors (ie, nonfatal suicide attempts, interrupted attempts, hospitalizations specifically to prevent suicidal behavior, and deaths by suicide) for lithium vs placebo of 1.10 (95% CI, 0.77-1.55), indicating that a treatment effect greater than 23% is unlikely. Manchia and colleagues state, “The findings contrast with a bulk of naturalistic and epidemiological data showing an evident suicide-protective effect with lithium.”

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