Citation

Geddes JR, Burgess S, Hawton KE, Jamison K, Goodwin GM. Am. J. Psychiatry 2004; 161(2): 217-222.

Affiliation

Department of Psychiatry, University of Oxford, Warneford Hospital, UK. john.geddes@psych.ox.ac.uk

Comment In:

Evid Based Ment Health 2004;7(3):72.

Copyright

(Copyright © 2004, American Psychiatric Association)

DOI

unavailable

PMID

14754766

Abstract

OBJECTIVE: The authors sought to determine the efficacy and acceptability of lithium for relapse prevention in bipolar disorder. METHOD: A systematic review and meta-analysis of randomized controlled trials comparing lithium with placebo in the long-term treatment of bipolar disorders was conducted. Data were obtained from searching the registers of the Cochrane Collaboration; reviewing reference lists, journals, and conference abstracts; and contacting authors, experts, and pharmaceutical companies. Outcomes investigated included risk of relapse (manic, depressive, and total) as well as risk of specific adverse effects and total withdrawal rates. RESULTS: Five randomized controlled trials (770 participants) were included. Lithium was more effective than placebo in preventing all relapses (random effects relative risk=0.65, 95% CI=0.50 to 0.84) and manic relapses (relative risk=0.62, 95% CI=0.40 to 0.95). The protective effect of lithium on depressive relapses was smaller and was less robust (relative risk=0.72, 95% CI=0.49 to 1.07). CONCLUSIONS: Lithium treatment reduces the risk of relapse in bipolar disorder. The preventive effect is clear for manic episodes, although it is equivocal for depressive episodes.

Language: en