Quetiapinev.lithium in the maintenance phase following a first episode of mania: Randomised controlled trial

Abstract

Lithium and quetiapine are considered standard maintenance agents for bipolar disorder yet it is unclear how their efficacy compares with each other.To investigate the differential effect of lithium and quetiapine on symptoms of depression, mania, general functioning, global illness severity and quality of life in patients with recently stabilised first-episode mania.Maintenance trial of patients with first-episode mania stabilised on a combination of lithium and quetiapine, subsequently randomised to lithium or quetiapine monotherapy (up to 800 mg/day) and followed up for 1 year. (Trial registration: Australian and New Zealand Clinical Trials Registry - ACTRN12607000639426.)In total, 61 individuals were randomised. Within mixed-model repeated measures analyses, significant omnibus treatment × visit interactions were observed for measures of overall psychopathology, psychotic symptoms and functioning. Planned and comparisons further demonstrated the superiority of lithium treatment over quetiapine.In people with first-episode mania treated with a combination of lithium and quetiapine, continuation treatment with lithium rather than quetiapine is superior in terms of mean levels of symptoms during a 1-year evolution.

Improving functional outcomes in early‐stage bipolar disorder: The protocol for the REsearch into COgnitive and behavioural VERsatility trial

“…RAPPt sits within the Early in Life Mental Health Service at Monash Health, in Dandenong and provides SEI services across the south‐eastern suburbs of Greater Melbourne. TAU at RAPPt is similar to that of OYH (Berk et al, ). This will allow meaningful inferences to be drawn about the effectiveness of RECOVER while having significant local differences to support generalizability should RECOVER prove effective as expected.…”

“…The outcome measures that have been selected have been widely used, including in our own trials with young people with first episode mania (Berk et al, ; Conus et al, ) and first episode psychosis (Killackey et al, ).…”

“…Given that illness severity and poor functioning are highly correlated in BD (Levy & Manove, ), it may be artificial to separate symptoms from functioning, when a composite measure may be more meaningful for young people. The GAF has been considered a valid measure of psychiatric disturbance in those with mental illness (Jones, Thornicroft, Coffey, & Dunn, ) and we have previously used the GAF in young people with psychotic mania (Berk et al, ; Conus et al, ). Furthermore, in our pilot study of RECOVER, the strongest treatment effects were observed for the GAF (Macneil 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

“…Notably, the only trials among these that did not use an enriched design favoring the drug of interest were the BALANCE trial and the olanzapine trial (in addition to the lithium [and placebo] arms in the quetiapine study and lamotrigine studies). Furthermore, a recent non‐enriched randomized 1‐year trial, which did not, however, include outcome measures of response rates or any measure of recurrence rate, found that maintenance monotherapy with lithium decreased overall psychopathology and improved some areas of cognition compared with maintenance monotherapy with quetiapine.…”

“…Furthermore, enrichment limits the generalizability of study results to patients treated under similar conditions and to patients with similar predominance of polarity in bipolar disorder . Among the mentioned trials, only a few pragmatic trials with head‐to‐head comparisons had reduced or no enrichment …”