ColumnsLithium Use for Suicide Prevention, RevisitedWortzel, Hal S. MD; Simonetti, Joseph A. MD, MPH; Oslin, David W. MD; Hermes, Eric MD; Matarazzo, Bridget B. PsyD Author Information WORTZEL: Michael K. Cooper Professor of Neurocognitive Disease, Director of Neuropsychiatry, Associate Professor in Psychiatry, Neurology, and Physical Medicine and Rehabilitation, and Faculty for the Forensic Psychiatry Fellowship at the University of Colorado, and Director of Neuropsychiatric Services for the Rocky Mountain MIRECC, Aurora, CO SIMONETTI: Division of Hospital Medicine, University of Colorado School of Medicine, Aurora, CO OSLIN: Professor of Psychiatry, Vice Chair for Veterans Health Department of Psychiatry, Perelman School of Medicine, Philadelphia, PA and Director VISN 4 Mental Illness Research, Education and Clinical Center, Crescenz VA Medical Center, Philadelphia, PA HERMES: Associate Professor of Psychiatry, Yale University School of Medicine, New Haven, CT and Director, Psychotropic Drug Safety Initiative, VA Office of Mental Health and Suicide Prevention, VA Connecticut Healthcare System, West Haven, CT MATARAZZO: Rocky Mountain Mental Illness Research, Education, and Clinical Center, Veterans Health Administration, and Departments of Psychiatry and Physical Medicine & Rehabilitation, University of Colorado School of Medicine Aurora, CO Supported in part by the Rocky Mountain Mental Illness Research, Education and Clinical Center for Suicide Prevention within the Department of Veterans Affairs. The views expressed are those of the authors and do not necessarily reflect the position or policy of the VA or the US Government. The authors declare no conflicts of interest. Please send correspondence to: Hal S. Wortzel, MD, G3-185, 1700 North Wheeling Street, Rocky Mountain Regional VA Medical Center, Aurora, CO 80045 (e-mail: [email protected]). Journal of Psychiatric Practice 29(1):p 51-57, January 2023. | DOI: 10.1097/PRA.0000000000000680 Buy Metrics Abstract The literature on lithium’s role in suicide prevention is rife with competing interpretations and diverging opinions, in part stemming from the complexity of the underlying literature base. Conclusions that lithium unequivocally offers suicide prevention benefits do not appear warranted based on the strength of existing studies. Given the evidence along with the indisputable risks associated with lithium (especially in overdose), and the need for sustained therapeutic dosing to achieve any theoretical antisuicide benefit, it seems evident that any potential role for lithium in suicide prevention is far narrower than originally hypothesized. As such, the goal of this article is to provide an evidence-informed, therapeutic risk management approach to clinical decision-making concerning the use of lithium for suicide prevention to ensure that such prescribing is done in a patient-centered fashion that mitigates, to the extent possible, the potential risks of lithium use. This includes a review of potential justifications for not employing lithium for suicide prevention, given the recommendations in the existing guidelines. Clinicians should approach this clinical decision in an individualized fashion with full consideration of the potential risks associated with lithium use and availability, as well as potential alternative treatment options. An individualized risk/benefit analysis must also take into consideration the presence of comorbid conditions; the acuity of suicide risk, and any history of self-directed violence, with special attention to suicide attempts via overdose; treatment adherence, past and present; the presence and/or strength of a therapeutic relationship; and other viable treatment options. Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.