What doses of lithium have you found effective in reducing suicidal ideation?

For depression augmentation in patients who have non-bipolar states, I generally use 150-450 mg (low-dose lithium). The blood levels usually range below therapeutic for bipolar, but the low-dose lithium can help reduce SI without too many side effects. I still watch for issues of thyroid and kidney effects.

If the patient has bipolar disorder, I usually opt to target appropriate blood levels. But, I was brought up to “treat the patient, not the number”, so I will have some patients who are stable on low-dose lithium as long as they do not have breakthrough symptoms.

I use 300 mg at night, and it has been very effective for reducing suicidality.

Even microgram doses in the drinking water bring down rates of suicide. Low doses work, e.g., 150 mg. It's patient-dependent. I'm curious if anyone has tried compounding doses lower than 150 mg.

Here's an analysis I included in a podcast series on lithium for those who are interested. Not every piece of evidence is going to back the same finding for any given clinical question; there seems to be almost always 2 debating sides on most issues.

I think you could create a data set that shows whatever you want it to show fairly easily. We see the pharmaceutical industry doing this regularly by cherry-picking data with a predetermined ‘destination’ or ‘outcome’ in mind. I also think other researchers can oftentimes be unaware of their inherent biases, and it’s important to regularly consider whether or not one’s opinions or conclusions are wrong, hence why the scientific method is predicated on TRYING TO DISPROVE THE NULL HYPOTHESIS, aka...

It seems it's more about time on it versus the dose of it. Not sure if there are any studies that address this.

I've often wondered about this. I tend to vary between 300 to 600 mg a day, which is the same dose range I use for augmenting antidepressants, but I don't have good evidence that this is better than 150 mg a day or some other strategy. Obviously, in Bipolar I, it makes sense to max out the lithium, as it works as well as any other mood stabilizer, and in that disorder, there is reasonable evidence for decreasing suicide risk. But how about in unipolar depression or borderline personality disorder?

And not all the studies show a decreased risk. One 2022 study looking only at randomized trials did not show a significant antisuicidal effect (Nabi et al., PMID 36111461). Nevertheless, when compared head to head with Depakote in Bipolar I, other ...