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Evidence summaries

Lithium for Schizophrenia

Lithium might not to be effective on its own for schizophrenia, but might possibly be beneficial as augmentation of antipsychotics, although the evidence is insufficient. Level of evidence: "D"

A Cochrane review [Abstract] 1 included 22 studies with a total of 763 patients.Most participants had schizophrenia. One study had a one year duration. Four studies were medium-term, with a duration of 13 to 19 weeks. All of the others were in the 'short-term' category, lasting between 3 and 8 weeks.Three small studies comparing lithium with placebo as the sole treatment showed no difference in any of the outcomes analysed.In 8 studies (n=270) comparing lithium with antipsychotic drugs as the sole treatment, more participants in the lithium group left the studies early (RR 1.77, 95% CI 1.01 to 3.11).Thirteen studies examined whether the augmentation of antipsychotic drugs with lithium is more effective than antipsychotic drugs alone. More participants who received lithium augmentation had a clinically significant response (RR 1.81, 95% CI 1.10 to 2.97; 10 RCTs, n=396). However, this effect became non-significant when the following studies were excluded: patients with schizoaffective disorders (RR 1.64, 95% CI 0.95 to 2.81; 7 RCTs; n = 272), non-double-blind studies (RR 1.82, 95% CI 0.84 to 3.96; 7 RCTs; n = 224), or studies with high attrition (RR 1.67, CI 0.93 to 3.00; 9 RCTs; n = 355). The overall acceptability of treatment (measured by the number of participants leaving the studies early) was not significantly different between the groups (RR 1.89, CI 0.93 to 3.84; 11 RCTs; n = 320). Few studies reported on side effects. For example, there were no data on thyroid dysfunction and kidney problems, which are two major and well-known side effects of lithium.

Comment: The quality of evidence is downgraded by study quality (unclear allocation concealment, high drop-out rate), imprecise results (few patients in each study) and indirectness (short follow-up time).

    References

    • Leucht S, Helfer B, Dold M et al. Lithium for schizophrenia. Cochrane Database Syst Rev 2015;10():CD003834. [PubMed]

Primary/Secondary Keywords