This systematic review indicates that lithium is more effective than placebo as a treatment for acute mania but increases the risk for somnolence and tremor .
Limited evidence suggests little or no difference between lithium and other mood stabilisers ( valproate , carbamazepine ) or antipsychotics ( risperidone , quetiapine , haloperidol ) .
Olanzapine may be an exception , as it is probably slightly more effective than lithium .
There is uncertain evidence that risperidone may also be more effective than lithium .
Lithium is probably more effective at treating acute mania than topiramate .
When compared to placebo , lithium was more likely to cause adverse events .
More , rigorously design ed , large-scale studies are needed to definitively conclude if lithium is superior to other interventions in treating acute mania
BACKGROUND Bipolar disorder is a common condition associated with high morbidity ; developing efficacious , safe treatments is therefore essential .
Lithium is an effective maintenance treatment for bipolar disorder .
It acts as mood stabiliser and reduces the risk of suicide .
However , evidence assessing the efficacy of lithium in the treatment of acute mania is less robust .
Current evidence -based guidelines cite multiple anti-dopaminergic and mood-stabilising agents as initial treatments : more definite evidence is needed to decide if lithium should be the first-line therapy .
OBJECTIVES 1 .
To assess the effects of lithium in comparison with placebo or other active treatment in alleviating the acute symptoms of a manic or mixed episode in people with bipolar disorder.2 .
To review the acceptability and tolerability of treatment with lithium in comparison with placebo or other active treatments in alleviating the acute symptoms of a manic or mixed episode in people with bipolar disorder .
A 40-week double-blind aripiprazole versus lithium follow-up of a 12-week acute phase study (total 52 weeks) in bipolar I disorder.
BACKGROUND This study followed manic or mixed bipolar I subjects for an additional 40 weeks after initial r and omization to 12 weeks of lithium versus aripiprazole monotherapy . This is the only long-term , double-blind study comparing lithium and aripiprazole . METHODS Patients continued receiving either aripiprazole 15 or 30 mg/day , or lithium 900 , 1200 or 1500 mg/day in a double-blind fashion for 40 weeks after completing a 12-week double-blind study ( 52 weeks total treatment ) . Efficacy endpoints included adjusted mean change from baseline to Week 52 in Young Mania Rating Scale ( YMRS ) total score and Montgomery-Åsberg Depression Rating Scale ( MADRS ) total scores ( observed cases ) . Remission was defined as YMRS total score≤12 . Safety and tolerability were also assessed . RESULTS Of the 66 patients who entered the extension phase , only 20 patients ( 30.3 % ) completed the entire phase ( aripiprazole n=7 ; lithium n=13 ) . The significant improvement that occurred over the first 12 weeks was maintained over the 40 weeks of blinded continuation ( from Week 12 through Week 52 ) . The most common treatment-emergent adverse events in the extension phase for aripiprazole  were akathisia , headache , somnolence , anxiety and nasopharyngitis ( all 8 % ) , and for lithium  were insomnia ( 15.8 % ) , headache ( 13.2 % ) , diarrhea ( 13.2 % ) and vomiting ( 10.5 % ) . Mean weight change was + 2.71 kg for lithium and + 5.66 kg for aripiprazole ( p=0.46 ) . LIMITATIONS This trial was not powered to statistically compare active treatments , and long-term completion rates were low in both groups . CONCLUSIONS Aripiprazole monotherapy appears to be equivalently useful to lithium for the extended treatment of mixed or manic bipolar disorder patients
This systematic review indicates that lithium is more effective than placebo as a treatment for acute mania but increases the risk for somnolence and tremor .
Limited evidence suggests little or no difference between lithium and other mood stabilisers ( valproate , carbamazepine ) or antipsychotics ( risperidone , quetiapine , haloperidol ) .
Olanzapine may be an exception , as it is probably slightly more effective than lithium .
There is uncertain evidence that risperidone may also be more effective than lithium .
Lithium is probably more effective at treating acute mania than topiramate .
When compared to placebo , lithium was more likely to cause adverse events .
More , rigorously design ed , large-scale studies are needed to definitively conclude if lithium is superior to other interventions in treating acute mania
BACKGROUND Bipolar disorder is a common condition associated with high morbidity ; developing efficacious , safe treatments is therefore essential .
Lithium is an effective maintenance treatment for bipolar disorder .
It acts as mood stabiliser and reduces the risk of suicide .
However , evidence assessing the efficacy of lithium in the treatment of acute mania is less robust .
Current evidence -based guidelines cite multiple anti-dopaminergic and mood-stabilising agents as initial treatments : more definite evidence is needed to decide if lithium should be the first-line therapy .
OBJECTIVES 1 .
To assess the effects of lithium in comparison with placebo or other active treatment in alleviating the acute symptoms of a manic or mixed episode in people with bipolar disorder.2 .
To review the acceptability and tolerability of treatment with lithium in comparison with placebo or other active treatments in alleviating the acute symptoms of a manic or mixed episode in people with bipolar disorder .