Effectiveness of maintenance therapy of lithium vs other mood stabilizers in monotherapy and in combinations: a systematic review of evidence from observational studies

Kessing, Lars Vedel; Bauer, Michael; Nolen, Willem A.; Severus, Emanuel; Goodwin, Guy M.; Geddes, John

doi:10.1111/bdi.12623

Cited by 99 publications

(98 citation statements)

References 57 publications

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“…There is ongoing debate as to the definition of the term mood stabiliser2,3 and, for the purposes of this review, we will use it to refer to the anticonvulsants and lithium. Lithium is widely regarded as the gold standard medication for mood stabilisation 4-6. However, perceived difficulties with prescribing lithium—its potential long‐term side effects on renal and thyroid function and the fact that monitoring blood levels is essential—have limited its use and, although it provides robust prophylaxis for approximately a third of patients with bipolar disorder,7 the remainder require alternative strategies, including anticonvulsants and antipsychotics.…”

Section: Introductionmentioning

confidence: 99%

Long‐acting injectable antipsychotics as maintenance treatments for bipolar disorder—A critical review of the evidence

et al. 2018

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Objectives The maintenance phase of bipolar disorder is arguably the most important. The aim of management during this time is to maintain wellness and prevent future episodes of illness. Medication is often the mainstay of treatment during this phase, but adherence to treatment is a significant problem. In recent years, long‐acting injectable (LAI) solutions have been proposed, but these too have limitations. This paper discusses the options that are currently available and critically appraises the effectiveness of this strategy. Method The authors reviewed the small number of open‐label and randomised studies on LAI medications in bipolar disorder and evaluated the efficacy and safety of these medications. Results The studies reviewed show benefit of LAIs for the management of bipolar disorder but have several key limitations to the generalisability of findings to routine practice. Conclusions LAIs have an emerging role in the management of bipolar disorder and, although it is not without limitations, this strategy addresses some issues of long‐term treatment and medication. Patients with bipolar disorder that are non‐adherent or have an unstable illness with a predilection towards mania are possibly better suited to the use of LAIs, though more research is required to fully assess the effectiveness of this approach.

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Section: Introductionmentioning

confidence: 99%

Long‐acting injectable antipsychotics as maintenance treatments for bipolar disorder—A critical review of the evidence

et al. 2018

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“…So clinicians, according to some international guidelines for the treatment of BD (Fountoulakis et al, ; Grunze et al, ), often utilize polypharmacy to improve the outcome (Lin, Mok, & Yatham, ). Nevertheless, evidence‐supported criteria for selecting Li monotherapy, anticonvulsant monotherapy, or polypharmacy are scant, and no compelling data suggesting that polypharmacy works better than Li monotherapy are available (BALANCE investigators and collaborators, Geddes et al, ; Goodwin et al, ; Grunze et al, ; Kemp et al, ; Kessing et al, ). Therefore, real‐world studies investigating the prescription patterns in psychiatric centers specialized in mood disorders might contribute to identify the best long‐term treatment for BD.…”

Section: Introductionmentioning

confidence: 99%

“…Lithium (Li) has been the standard prophylactic treatment of BD since 1960s, and it is still the first-line therapy for long-term management of bipolar patients, as highlighted by several observational and randomized clinical trials (Bowden et al, 2010;Hayes et al, 2016;Kessing et al, 2018;Kessing, Hellmund, Geddes, Goodwin, & Andersen, 2011;Lähteenvuo et al, 2018;Malhi et al, 2012;Malhi & Outhred, 2016;Muzina & Calabrese, 2005;Nolen, 2015;Yildiz, Vieta, Tohen, & Baldessarini, 2011). Clinical predictors of good response to Li prophylaxis are BD-I diagnosis, manic index polarity, pure mania, full interepisodic remission, few previous psychiatric hospitalizations, low somatic comorbidity, and positive response to lithium in first-degree relatives (Gershon, Chengappa, & Malhi, 2009;Grof, 2010;Grof et al, 2002;Kleindienst, Engel, & Greil, 2005;Licht, 2012).…”

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confidence: 99%

“…Clinical predictors of good response to VA or CBZ are the presence of mixed or psychotic features (Fountoulakis et al, 2012;Goodwin & Consensus Group of the British Association for Psychopharmacology, 2009; Grunze et al, 2009;Masi et al, 2010;Swann et al, 1997;Tundo et al, 2013;Yatham et al, 2013) and of anxiety disorders comorbidity (Malhi, McAulay, Das, & Fritz, 2015). However, there is some evidence that does not support the efficacy of VA or CBZ monotherapy in the maintenance treatment of BD or their efficacy advantages over lithium monotherapy (Hartong et al, 2003;Hayes et al, 2016;Kessing et al, 2018Kessing et al, , 2011. The better response to VA or CBZ than to Li monotherapy in patients with rapid cycling course BD is still disputed (Fountoulakis et al, 2016;Post et al, 2016).…”

mentioning

confidence: 99%

“…Despite these different pharmacological options, longterm treatment of BD with a conventional agent (Li, VA, or CBZ) monotherapy often fails (Bromet et al, 2005;Fekadu et al, 2006;Li, Chen, Qiu, & Yang, 2014;Simhandl, König, & Amann, 2014). So clinicians, according to some international guidelines for the treatment of BD (Fountoulakis et al, 2016;Grunze et al, 2013), often utilize polypharmacy to improve the outcome (Lin, Mok, & Yatham, 2006 Geddes et al, 2010;Goodwin et al, 2007;Grunze et al, 2013;Kemp et al, 2009;Kessing et al, 2018). Therefore, real-world studies investigating the prescription patterns in psychiatric centers specialized in mood disorders might contribute to identify the best long-term treatment for BD.…”

mentioning

confidence: 99%

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Lithium, valproate, and carbamazepine prescribing patterns for long‐term treatment of bipolar I and II disorders: A prospective study

Musetti

Tundo

Benedetti

et al. 2018

Human Psychopharmacology

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Objective This study aims to describe the prescription patterns of the mood stabilizers most commonly used for the treatment of bipolar I and II disorders (lithium, valproate, and carbamazepine) and to analyze the treatment outcomes. Methods Two hundred and thirty‐four outpatients with bipolar disorders receiving prophylactic treatment with lithium, valproate, carbamazepine, or their combination were followed up for at least 18 months in two Italian psychiatric centers specialized in mood disorders. Results The combination of lithium and valproate or carbamazepine was the most common prophylactic treatment (54.3%), followed by valproate or carbamazepine (24%) and lithium monotherapy (22%). Polytherapy was prescribed mainly to patients with bipolar I disorder, a high number of previous episodes and lifetime psychotic symptoms, whereas valproate or carbamazepine monotherapy was prescribed to patients with anxiety comorbidity. The annual frequency of recurrences decreased significantly after entering the study in the overall sample, and the reduction was significantly higher in patients on lithium plus valproate or carbamazepine compared with the valproate or carbamazepine group, but not with the lithium monotherapy group. The number of mixed recurrences during the follow‐up was significantly higher in patients on lithium plus valproate or carbamazepine. Conclusions Our findings may help clinicians to personalize long‐term treatment to prevent relapses of bipolar disorder according to clinical presentation.

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Bipolar Disorder

2021

The Maudsley Prescribing Guidelines in Psychiatry

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This chapter provides expert guidance on mechanism of action of lithium, valproate, and carbamazepine as well as their formulations, indications, plasma levels, adverse effects, and prescribing for special patient groups. Calcium‐related genes have been implicated by genetic studies in bipolar disorder (BD). Clinical studies of the treatment of affective disorders variably use sodium valproate, semi‐sodium valproate, ‘valproate’ or valproic acid. Antipsychotics have been used in acute and maintenance treatment of BD since the 1960s, with evidence to suggest effectiveness at both poles of the illness, as well as mixed states. Oral paliperidone prevents manic relapse in BD and case reports describe good outcomes with the long‐acting injections form. Bipolar depression shares the same diagnostic criteria for a major depressive episode in major depressive disorder but episodes may differ in severity, time course, liability to recurrence and response to drug treatment.

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Effectiveness of maintenance therapy of lithium vs other mood stabilizers in monotherapy and in combinations: a systematic review of evidence from observational studies

Cited by 99 publications

References 57 publications

Long‐acting injectable antipsychotics as maintenance treatments for bipolar disorder—A critical review of the evidence

Long‐acting injectable antipsychotics as maintenance treatments for bipolar disorder—A critical review of the evidence

Lithium, valproate, and carbamazepine prescribing patterns for long‐term treatment of bipolar I and II disorders: A prospective study

Bipolar Disorder

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