Effectiveness of maintenance therapy of lithium vs other mood stabilizers in monotherapy and in combinations: a systematic review of evidence from observational studies

Lars Vedel Kessing*, Michael Bauer, Willem A. Nolen, Emanuel Severus, Guy M. Goodwin, John Geddes

*Corresponding author for this work

Research output: Contribution to journalReview articleAcademicpeer-review

38 Citations (Scopus)

Abstract

ObjectivesFor the first time to present a systematic review of observational studies on the efficiency of lithium monotherapy in comparison with other maintenance mood stabilizers in monotherapy and in combination.

MethodsAs part of the International Society for Bipolar Disorders (ISBD) Task Force on Lithium Treatment, we undertook a systematic literature search of non-randomized controlled observational studies on (i) lithium monotherapy vs treatment with another maintenance mood stabilizer in monotherapy and (ii) lithium in combination with other mood stabilizers vs monotherapy.

ResultsIn eight out of nine identified studies including a total of <14000 patients, maintenance lithium monotherapy was associated with improved outcome compared with another mood stabilizer in monotherapy, including valproate, lamotrigine, olanzapine, quetiapine, unspecified anticonvulsants, carbamazepine/lamotrigine, unspecified atypical antipsychotics and unspecified antipsychotics. Among the four identified studies including a total of > 4000 patients comparing maintenance combination therapy with maintenance monotherapy, a few combination therapies were found to be superior to monotherapy in some analyses, but many were not.

ConclusionsThe results show the superiority in real life of lithium monotherapy compared with monotherapy with other maintenance mood stabilizers. The four largest register-based studies largely addressed confounding, but, as ever, residual confounding cannot be excluded. Nevertheless, the observational findings substantially add to the findings from randomized controlled trials, whose designs often limit the validity of comparison between medicines.

Original languageEnglish
Pages (from-to)419-431
Number of pages13
JournalBipolar Disorders
Volume20
Issue number5
DOIs
Publication statusPublished - Aug-2018

Keywords

  • bipolar disorder
  • lithium
  • mania
  • mood stabilizer
  • non-randomized trial
  • observational
  • BIPOLAR-I-DISORDER
  • ANTIDEPRESSANT EFFICACY TRIAL
  • RANDOMIZED CONTROLLED-TRIAL
  • CONTROLLED 18-MONTH TRIAL
  • REGISTER-BASED COHORT
  • LONG-TERM TREATMENT
  • FOLLOW-UP
  • PHARMACOLOGICAL-TREATMENT
  • REHOSPITALIZATION RATES
  • RELAPSE PREVENTION

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