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 .
GERI-BD: A Randomized Double-Blind Controlled Trial of Lithium and Divalproex in the Treatment of Mania in Older Patients With Bipolar Disorder.
OBJECTIVE Clinicians treating older patients with bipolar disorder with mood stabilizers need evidence from age-specific r and omized controlled trials . The authors describe findings from a first such study of late-life mania . METHOD The authors compared the tolerability and efficacy of lithium carbonate and divalproex in 224 in patients and out patients age 60 or older with bipolar I disorder who presented with a manic , hypomanic , or mixed episode . Participants were r and omly assigned , under double-blind conditions , to treatment with lithium ( target serum concentration , 0.80 - 0.99 mEq/L ) or divalproex ( target serum valproate concentration , 80 - 99 μg/mL ) for 9 weeks . Participants with an inadequate response after 3 weeks received open adjunctive risperidone . The authors hypothesized that divalproex would be better tolerated and more efficacious than lithium  . Tolerability was assessed based on a measure of sedation and on the proportions of participants achieving target concentrations . Efficacy was assessed with the Young Mania Rating Scale ( YMRS ) . RESULTS Attrition rates were similar for lithium and divalproex ( 14 % and 18 % at week 3 and 51 % and 44 % at week 9 , respectively ) . The groups did not differ significantly in sedation . Participants in the lithium group tended to experience more tremor . Similar proportions of participants in the lithium and divalproex groups achieved target concentrations ( 57 % and 56 % , respectively ) . A longitudinal mixed model of improvement ( change from baseline in YMRS score ) favored lithium ( change in score , 3.90 ; 97.5 % CI=1.71 , 6.09 ) . Nine-week response rates did not differ significantly between the lithium and divalproex groups ( 79 % and 73 % , respectively ) . The need for adjunctive risperidone was low and similar between groups ( 17 % and 14 % , respectively ) . CONCLUSIONS Both lithium and divalproex  were adequately tolerated and efficacious ; lithium was associated with a greater reduction in mania scores over 9 weeks
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 .