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 .
Response and remission rates in Chinese patients with bipolar mania treated for 4 weeks with either quetiapine or lithium: a randomized and double-blind study
ABSTRACT Objective : To assess the efficacy and tolerability of quetiapine in Chinese patients hospitalized with acute bipolar mania . Methods : This was a 4-week , multicenter , r and omized , double-blind , lithium-controlled , parallel-group study . Secondary endpoints in the primary analysis were : response rate ( ≥ 50 % decrease from baseline in YMRS total score ) and remission rate as defined using 3 criteria : YMRS total score ≤ 12 , YMRS total score ≤ 12 + MADRS total score ≤ 8 , and YMRS total score ≤ 8 . Other measures included : change from baseline at Day 28 in YMRS , PANSS , and MADRS total score . Adverse event ( AE ) data were collected throughout the study . Results : 73 ( 94.8 % ) quetiapine and 62 ( 80.5 % ) lithium patients completed the study .  Mean ( SD ) quetiapine  doses for the ITT population and responders were 648.2 ( 111.84 ) mg/day and 637.5 ( 118.78 ) mg/day , respectively , while mean lithium concentrations for the ITT population and responders were 0.80 ( 0.28 ) mmol/L and 0.80 ( 0.22 ) mmol/L , respectively . Of patients who responded to quetiapine at Day 28 , 88.3 % were receiving 600–800 mg/day . At Day 28 YMRS response rate was significantly greater with quetiapine than lithium ( 77.9 % vs. 59.7 % , p = 0.0132 ) , and remission rates using the 3 criteria were significantly greater with quetiapine than lithium  : YMRS total score ≤ 12 ( 70.1 % vs. 48.1 % , p = 0.0071 ) , YMRS ≤ 12 + MADRS ≤ 8 ( 70.1 % vs. 48.1 % ; p = 0.0071 ) , and YMRS ≤ 8 ( 51.9 % vs. 32.5 % ; p = 0.0147 ) . Significant decreases were observed in PANSS , YMRS , and MADRS total scores for both groups . The most common AEs experienced by patients receiving quetiapine  were constipation , dizziness , diarrhea , alanine aminotransferase increase , palpitations , aspartate aminotransferase increase , pharyngolaryngeal pain , upper respiratory tract infection and dry mouth . In patients receiving lithium , the most common AEs were nausea ( 16.9 % ) , constipation ( 13.0 % ) , vomiting ( 13.0 % ) , nasopharyngitis ( 11.7 % ) , dizziness ( 6.5 % ) , diarrhea ( 6.5 % ) , and upper respiratory tract infection ( 6.5 % ) . Conclusion : Quetiapine was shown to be clinical ly effective in patients with acute bipolar mania . There were side effects with quetiapine similar to those reported in other studies that included other ethnic population s of 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 .