A Cochrane review [Abstract] 1 included 9 studies with a total of 825 subjects. Lithium was more effective than placebo in preventing relapse in mood disorder overall and in bipolar disorder. The most consistent effect was found in bipolar disorder (OR 0.29, 95% CI 0.09 to 0.93). Considerable heterogeneity was seen between studies in all groups of patients. The review did not cover studies comparing lithium to other treatments.
A systematic review 2 included 20 studies of which 12 with a total of 658 subjects were pooled and abstracted in DARE.
Patients were twice as likely to obtain remission with lithium than with chlorpromazine (rate ratio = 1.96, 95% CI 1.02 to 3.77). The mean NNT was 4 (95% CI 3 to 9). Neither carbamazepine nor valproate was more effective than lithium. Haloperidol was no better than lithium on the basis of improvement based on assessment of global severity. The differences in effects between lithium and risperidone were -2.79 (95% CI -4.22 to -1.36) in favour of risperidone with respect to symptom severity improvement and -0.76 (95% CI -1.11 to -0.41) on the basis of reduction in global severity of disease. Symptom and global severity was as well controlled with lithium as with verapamil. Lithium caused more side-effects than placebo and verapamil, but no more than carbamazepine or valproate.
The authors recommend that lithium should remain the first line of treatment for acute mania.
Comment: The quality of evidence is downgraded by inconsistency (heterogeneity in results in different populations).
Primary/Secondary Keywords