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 .
Aripiprazole monotherapy in the treatment of acute bipolar I mania: a randomized, double-blind, placebo- and lithium-controlled study.
OBJECTIVES To evaluate the efficacy and safety of aripiprazole as acute and maintenance of effect monotherapy for acute bipolar mania . METHODS Patients with acute bipolar I mania ( DSM-IV-TR : YMRS > or = 20 ) , manic or mixed ( with or without psychotic features ) were r and omized to double-blind aripiprazole ( 15 - 30 mg/day ; n=155 ) , placebo ( n=165 ) or lithium ( 900 - 1500 mg/day ; n=160 ) ( 1:1:1 ) for 3 weeks . Aripiprazole- and lithium-treated patients remained on blinded treatment for 9 additional weeks . The primary outcome was the mean change from baseline in YMRS Total score ( LOCF ) to Week 3 . Secondary outcomes included the mean change from baseline in YMRS Total score ( LOCF ) at all other timepoints up to Week 12 . RESULTS Aripiprazole demonstrated significantly greater improvement than placebo in mean YMRS Total score from baseline to Day 2 ( -4.3 vs.-2.8 ; p=0.003 ) , and up to Week 3 ( -12.6 vs. -9.0 ; p<0.001 ) . Significant improvement in YMRS Total score was also seen with lithium versus placebo at Week 3 ( -12.0 vs. -9.0 ; p=0.005 ) . Improvements in YMRS Total score were maintained to Week 12 for aripiprazole ( -14.5 ) and lithium ( -12.7 ) . Response rates at Week 3 were significantly higher with aripiprazole ( 46.8 % ) and lithium ( 45.8 % ) than placebo ( 34.4 % ; both p<0.05 , LOCF ) ; increasing to Week 12 with aripiprazole ( 56.5 % ) and lithium ( 49.0 % ) . Most common adverse events with aripiprazole were headache , nausea , akathisia , sedation , and constipation ; with lithium were nausea , headache , constipation , and tremor . CONCLUSIONS Aripiprazole provided statistically significant improvement of acute mania within 2 days , continuing over 3 weeks and sustained over 12 weeks . The magnitude of improvement to Week 12 was similar with aripiprazole and lithium
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 .