Lithium for Acute Mania

Summary

A Cochrane review [Abstract] 1 included 36 studies with a total of 4220 subjects. Lithium was found to be an effective treatment for acute mania and was more effective than placebo at inducing a response (OR 2.13, 95% CI 1.73 to 2.63; n = 1707; 6 studies; high-certainty evidence), or remission (OR 2.16, 95% CI 1.73 to 2.69; n = 1597; 5 studies; high-certainty evidence).

For the comparison of lithium and other mood stabilisers (carbamazepine, topiramate, valproate) or antipsychotics (haloperidol, olanzapine, quetiapine, risperidone), there seemed to be little or no difference in inducing a response. There was only low-certainty evidence of lithium compared to haloperidol (MD −2.40, 95% CI −6.31 to 1.50; n = 80; 3 studies), quetiapine (OR 0.66, 95% CI 0.28 to 1.55; n = 335; 2 studies), and carbamazepine (SMD 0.21, 95% CI −0.18 to 0.60; n = 102; 3 studies). Lithium was probably less likely to induce a response than olanzapine (OR 0.44, 95% CI 0.20 to 0.94; n = 180; 2 studies; moderate-certainty evidence). Lithium may be less likely to induce a response than risperidone (MD 7.28, 95% CI 5.22 to 9.34; n = 241; 3 studies; low-certainty evidence). There was no evidence of a difference between lithium and valproate (OR 1.22, 95% CI 0.87 to 1.70; n = 607; 5 studies; moderate-certainty evidence). Lithium was more effective than topiramate (OR 2.28, 95% CI 1.63 to 3.20; n = 660; 1 study; moderate-certainty evidence).