PDF herunterladen
Pharmacopsychiatry 2018; 51(05): 173-176
DOI: 10.1055/a-0627-7489
Review
© Georg Thieme Verlag KG Stuttgart · New York

Efficacy and Effectiveness of Lithium in the Long-Term Treatment of Bipolar Disorders: An Update 2018

Emanuel Severus
1   Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany
,
Michael Bauer
1   Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany
,
John Geddes
2   Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford OX3 7JX, United Kingdom
› Institutsangaben
Weitere Informationen

Publikationsverlauf

received 18. März 2018
revised  29. April 2018

accepted 02. Mai 2018

Publikationsdatum:
13. Juni 2018 (online)

Auch verfügbar auf
   Lizenzen und Reprints

Abstract

For more than 40 years, lithium has been the gold standard in the long-term treatment of bipolar disorders. In the course of the last 15 years, other drugs have been approved in this indication and are widely used in clinical practice at the expense of lithium. New research from the last few years, however, indicates that lithium is still the first-line treatment in this indication. Against this background and lithium’s proven acute antimanic efficacy, we should perhaps be using lithium more regularly (in combination with an atypical antipsychotic, if necessary) right from the start for the acute treatment of a manic episode and, once remission has been achieved and euthymia maintained during continuation treatment, to regularly taper off the atypical antipsychotic, if possible, and continue with lithium as monotherapy for prophylactic treatment. This might lead to lithium being used more consistently with the scientific evidence in the long-term treatment of bipolar disorders. It remains uncertain, however, to predict who will respond to and tolerate lithium prophylactically, and more research is needed to deliver the best possible individualized care to our patients.

Key words

lithium - bipolar disorders - long-term treatment - maintenance treatment - efficacy
 

  • References

  • 1 Geddes JR, Burgess S, Hawton K. et al. Long-term lithium therapy for bipolar disorder: Systematic review and meta-analysis of randomized controlled trials. Am J Psychiatry 2004; 161: 217-222
    CrossrefPubMedGoogle Scholar
  • 2 Young AH, Hammond JM. Lithium in mood disorders: Increasing evidence base, declining use?. Br J Psychiatry 2007; 191: 474-476
    CrossrefPubMedGoogle Scholar
  • 3 Kessing LV, Vradi E, Andersen PK. Nationwide and population-based prescription patterns in bipolar disorder. Bipolar Disord 2016; 18: 174-182
    CrossrefPubMedGoogle Scholar
  • 4 Severus E, Taylor MJ, Sauer C. et al Lithium for prevention of mood episodes in bipolar disorders: Systematic review and meta-analysis. Int J Bipolar Disord 2014; 2: 15
    CrossrefPubMedGoogle Scholar
  • 5 Miura T, Noma H, Furukawa TA. et al. Comparative efficacy and tolerability of pharmacological treatments in the maintenance treatment of bipolar disorder: A systematic review and network meta-analysis. Lancet Psychiatry 2014; 1: 351-359
    PubMedGoogle Scholar
  • 6 Licht RW, Severus E. Letter to the editor: Is it valid to break down results from long-term trials in bipolar disorder by polarity of relapses?. Int J Bipolar Disord 2014; 2: 8
    CrossrefPubMedGoogle Scholar
  • 7 Gitlin M. Lithium side effects and toxicity: Prevalence and management strategies. Int J Bipolar Disord 2016; 4: 27
    CrossrefPubMedGoogle Scholar
  • 8 Hayes JF, Marston L, Walters K. et al. Adverse renal, endocrine, hepatic, and metabolic events during maintenance mood stabilizer treatment for bipolar disorder: A population-based cohort study. PLoS Med 2016; 13: e1002058
    CrossrefPubMedGoogle Scholar
  • 9 McKnight RF, Adida M, Budge K. et al. Lithium toxicity profile: A systematic review and meta-analysis. Lancet 2012; 379: 721-728
    CrossrefPubMedGoogle Scholar
  • 10 Kendall T, Morriss R, Mayo-Wilson E. et al. Assessment and management of bipolar disorder: Summary of updated NICE guidance. BMJ 2014; 349: g5673
    CrossrefPubMedGoogle Scholar
  • 11 Nolen WA. More robust evidence for the efficacy of lithium in the long-term treatment of bipolar disorder: Should lithium (again) be recommended as the single preferred first-line treatment?. Int J Bipolar Disord 2015; 3: 1
    CrossrefPubMedGoogle Scholar
  • 12 Grunze H. Treatment of bipolar disorder: Not another meta-analysis. Lancet Psychiatry 2014; 1: 321-323
    CrossrefPubMedGoogle Scholar
  • 13 Lewitzka U, Severus E, Bauer R. et al The suicide prevention effect of lithium: More than 20 years of evidence-a narrative review. Int J Bipolar Disord 2015; 3: 32
    PubMedGoogle Scholar
  • 14 Cipriani A, Hawton K, Stockton S. et al. Lithium in the prevention of suicide in mood disorders: updated systematic review and meta-analysis. BMJ 2013; 346: f3646
    CrossrefPubMedGoogle Scholar
  • 15 Abou-Saleh MT, Muller-Oerlinghausen B, Coppen AJ. Lithium in the episode and suicide prophylaxis and in augmenting strategies in patients with unipolar depression. Int J Bipolar Disord 2017; 5: 11
    CrossrefPubMedGoogle Scholar
  • 16 Bowden CL, Mintz J, Tohen M. Multi-state outcome analysis of treatments (MOAT): Application of a new approach to evaluate outcomes in longitudinal studies of bipolar disorder. Mol Psychiatry 2016; 21: 237-242
    CrossrefPubMedGoogle Scholar
  • 17 Tohen M, Mintz J, Bowden CL. Analysis of bipolar maintenance treatment with lithium versus olanzapine utilizing Multi-State Outcome Analysis of Treatments (MOAT). Bipolar Disord 2016; 18: 282-287
    CrossrefPubMedGoogle Scholar
  • 18 Nierenberg AA, McElroy SL, Friedman ES. et al. Bipolar CHOICE (Clinical Health Outcomes Initiative in Comparative Effectiveness): A pragmatic 6-month trial of lithium versus quetiapine for bipolar disorder. J Clin Psychiatry 2016; 77: 90-99
    CrossrefPubMedGoogle Scholar
  • 19 Weisler RH, Nolen WA, Neijber A. et al. Continuation of quetiapine versus switching to placebo or lithium for maintenance treatment of bipolar I disorder (trial 144: a randomized controlled study). J Clin Psychiatry 2011; 72: 1452-1464
    CrossrefPubMedGoogle Scholar
  • 20 Cipriani A, Barbui C, Rendell J. et al. Clinical and regulatory implications of active run-in phases in long-term studies for bipolar disorder. Acta Psychiatr Scand 2014; 129: 328-342
    CrossrefPubMedGoogle Scholar
  • 21 Gyulai L, Bowden CL, McElroy SL. et al. Maintenance efficacy of divalproex in the prevention of bipolar depression. Neuropsychopharmacology 2003; 28: 1374-1382
    CrossrefPubMedGoogle Scholar
  • 22 Bowden CL, Calabrese JR, McElroy SL. et al A randomized, placebo-controlled 12-month trial of divalproex and lithium in treatment of outpatients with bipolar I disorder. Divalproex Maintenance Study Group. Arch Gen Psychiatry 2000; 57: 481-489
    CrossrefPubMedGoogle Scholar
  • 23 Calabrese JR, Vieta E, El-Mallakh R. et al Mood state at study entry as predictor of the polarity of relapse in bipolar disorder. Biol Psychiatry 2004; 56: 957-963
    CrossrefPubMedGoogle Scholar
  • 24 Popovic D, Torrent C, Goikolea JM. et al. Clinical implications of predominant polarity and the polarity index in bipolar disorder: A naturalistic study. Acta Psychiatr Scand 2014; 129: 366-374
    CrossrefPubMedGoogle Scholar
  • 25 Calabrese JR, Bowden CL, Sachs G. et al A placebo-controlled 18-month trial of lamotrigine and lithium maintenance treatment in recently depressed patients with bipolar I disorder. J Clin Psychiatry 2003; 64: 1013-1024
    CrossrefPubMedGoogle Scholar
  • 26 Bowden CL, Calabrese JR, Sachs G. et al A placebo-controlled 18-month trial of lamotrigine and lithium maintenance treatment in recently manic or hypomanic patients with bipolar I disorder. Arch Gen Psychiatry 2003; 60: 392-400
    CrossrefPubMedGoogle Scholar
  • 27 Severus WE, Lipkovich IA, Licht RW. et al In search of optimal lithium levels and olanzapine doses in the long-term treatment of bipolar I disorder. A post-hoc analysis of the maintenance study by Tohen et al. 2005. Eur Psychiatry 2010; 25: 443-449
    PubMedGoogle Scholar
  • 28 Tohen M, Frank E, Bowden CL. et al The International Society for Bipolar Disorders (ISBD) Task Force report on the nomenclature of course and outcome in bipolar disorders. Bipolar Disord 2009; 11: 453-473
    CrossrefPubMedGoogle Scholar
  • 29 Maj M, Starace F, Nolfe G. et al. Minimum plasma lithium levels required for effective prophylaxis in DSM III bipolar disorder: A prospective study. Pharmacopsychiatry 1986; 19: 420-423
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 30 Berk M, Daglas R, Dandash O. et al. Quetiapine v. lithium in the maintenance phase following a first episode of mania: Randomised controlled trial. Br J Psychiatry 2017; 210: 413-421
    CrossrefPubMedGoogle Scholar
  • 31 Berk M, Dandash O, Daglas R. et al. Neuroprotection after a first episode of mania: A randomized controlled maintenance trial comparing the effects of lithium and quetiapine on grey and white matter volume. Transl Psychiatry 2017; 7: e1041
    CrossrefPubMedGoogle Scholar
  • 32 Hayes JF, Marston L, Walters K. et al. Lithium vs. valproate vs. olanzapine vs. quetiapine as maintenance monotherapy for bipolar disorder: A population-based UK cohort study using electronic health records. World Psychiatry 2016; 15: 53-58
    CrossrefPubMedGoogle Scholar
  • 33 Lähteenvuo M, Tanskanen A, Taipale H. et al. Real-world effectiveness of pharmacologic treatments for the prevention of rehospitalization in a Finnish nationwide cohort of patients with bipolar disorder. JAMA Psychiatry 2018; 75: 347-355
    CrossrefPubMedGoogle Scholar
  • 34 Kessing LV, Bauer M, Nolen WA et al. Effectiveness of maintenance therapy of lithium vs other mood stabilizers in monotherapy and in combinations: A systematic review of evidence from observational studies. Bipolar Disord 2018 [Epub ahead of print]
    PubMed
  • 35 Post RM. The new news about lithium: An underutilized treatment in the United States. Neuropsychopharmacology 2018; 43: 1174-1179
    CrossrefPubMedGoogle Scholar
  • 36 Stokes PE, Shamoian CA, Stoll PM. et al. Efficacy of lithium as acute treatment of manic-depressive illness. Lancet 1971; 1: 1319-1325
    PubMedGoogle Scholar
  • 37 Bourin MS, Severus E, Schronen JP. et al Lithium as add-on to quetiapine XR in adult patients with acute mania: A 6-week, multicenter, double-blind, randomized, placebo-controlled study. Int J Bipolar Disord 2014; 2: 14
    CrossrefPubMedGoogle Scholar
  • 38 Pfennig A, Bschor T, Baghai T. et al [S3 guidelines on diagnostics and therapy of bipolar disorders: Development process and essential recommendations]. Nervenarzt 2012; 83: 568-586
    CrossrefPubMedGoogle Scholar
  • 39 Ahn SW, Baek JH, Yang SY. et al. Long-term response to mood stabilizer treatment and its clinical correlates in patients with bipolar disorders: A retrospective observational study. Int J Bipolar Disord 2017; 5: 24
    CrossrefPubMedGoogle Scholar
  • 40 Bocchetta A, Cabras F, Pinna M. et al. An observational study of 110 elderly lithium-treated patients followed up for 6 years with particular reference to renal function. Int J Bipolar Disord 2017; 5: 19
    CrossrefPubMedGoogle Scholar
  • 41 Bocchetta A, Ambrosiani L, Baggiani G. et al. Circulating antithyroid antibodies contribute to the decrease of glomerular filtration rate in lithium-treated patients: A longitudinal study. Int J Bipolar Disord 2018; 6: 3
    CrossrefPubMedGoogle Scholar
  • 42 Tondo L, Abramowicz M, Alda M. et al. Long-term lithium treatment in bipolar disorder: Effects on glomerular filtration rate and other metabolic parameters. Int J Bipolar Disord 2017; 5: 27
    CrossrefPubMedGoogle Scholar
  • 43 Pinna M, Manchia M, Puddu S. et al Cutaneous adverse reaction during lithium treatment: A case report and updated systematic review with meta-analysis. Int J Bipolar Disord 2017; 5: 20
    CrossrefPubMedGoogle Scholar