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 .
Lithium vs. valproate vs. olanzapine vs. quetiapine as maintenance monotherapy for bipolar disorder: a population-based UK cohort study using electronic health records.
It is unclear which maintenance treatment for bipolar disorder is superior in clinical practice . R and omized controlled head-to-head trials of available drugs either do not exist or are inconclusive . We aim ed to compare rates of monotherapy treatment failure in individuals prescribed lithium , valproate , olanzapine or quetiapine  by a population -based cohort study using electronic health records . 5,089 patients with bipolar disorder were prescribed  lithium ( N=1,505 ) , valproate ( N=1,173 ) olanzapine ( N=1,366 ) or quetiapine ( N=1,075 ) as monotherapy . Treatment failure was defined as time to stopping medication or add-on of another mood stabilizer , antipsychotic , antidepressant or benzodiazepine . In unadjusted analyses , the duration of successful monotherapy was longest in individuals treated with lithium .  Treatment failure had occurred in 75 % of those prescribed lithium by 2.05 years ( 95 % CI : 1.63 - 2.51 ) , compared to 0.76 years ( 95 % CI : 0.64 - 0.84 ) for those prescribed quetiapine , 0.98 years ( 95 % CI : 0.84 - 1.18 ) for those prescribed valproate , and 1.13 years for those prescribed olanzapine ( 95 % CI : 1.00 - 1.31 ) . Lithium 's superiority remained in a propensity score matched analysis ; when treatment failure was defined as stopping medication or add-on of a mood stabilizer or antipsychotic ; and when treatment failure was restricted to more than three months after commencing the study drug . Lithium appears to be more successful as monotherapy maintenance treatment than valproate , olanzapine or quetiapine . Lithium is often avoided because of its side effect profile , but alternative treatments may reduce the time to being prescribed more than one drug , with potential additive side effects of these treatments
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 .