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 .
Comparison of the antimanic efficacy of carbamazepine and lithium carbonate by double-blind controlled study.
A multi-institutional study comparing the antimanic effect of carbamazepine ( CBZ ) and lithium carbonate ( Li ) was performed using a double-blind group comparison design in a series of 105 patients with bipolar disorders .  CBZ and Li were given for four weeks using a fixed-flexible method at an equipotent dose ratio of 1:1 , starting from an initial dosage of 400 mg with a maximum dosage of 1200 mg . The final global improvement rate , based on the number of cases showing moderate to marked amelioration of manic symptoms , was 62 % in the CBZ group and 59 % in the Li group , with no significant difference being found between the two groups . Incidence of cutaneous side-effects was significantly higher in the CBZ group . The mean daily dosage and serum level of CBZ  in the fourth week were 674 + /- 239 mg and 7.3 + /- 2.4 micrograms/ml respectively ; these were within the therapeutic range . The daily dose and serum level of Li  , however , were 710 + /- 239 mg and 0.46 + /- 0.22 mEq/l , and the  Li level seemed to be too low to compare its therapeutic effect with that of CBZ . Prior to the present study , approximately 80 % of the patients in both groups had been receiving antipsychotic medication , equivalent to 8.0 mg of haloperidol on average , without favorable response . This medication was maintained unchanged during treatment . While the shortcomings of the present study limit the interpretation of the data , it may be suggested that the usefulness of CBZ as a drug for the treatment of manic states is comparable to that of Li
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 .