How does lithium compare with mood stabilizers for people with acute mania?

Abstract

For adults with acute mania, the effects of lithium compared with different mood stabilizers were mixed, and although differences were noted, few reached statistical significance. The comparative adverse effect pattern differed by mood stabilizer.RCT evidence indicates little or no difference in response, remission, or withdrawal from treatment for any cause when lithium was compared with valproate or quetiapine. Evidence was primarily of moderate to high certainty for comparative effects of lithium versus valproate, and of very low certainty for comparative effects of lithium versus quetiapine. Lithium may be associated with fewer instances of somnolence but more instances of headache or tremor compared with valproate, and, when compared with use of quetiapine, treatment with lithium may result in fewer people experiencing dizziness or weight gain.When lithium is compared with lamotrigine or carbamazepine, there are probably no important differences between groups in response to treatment nor in adverse effects (very low‐ to moderate‐certainty evidence).Fewer people may withdraw from treatment with lithium than with carbamazepine for any cause (on average, 67 vs 263 per 1000 people); however, this result is based on an RCT including only 34 people.Fewer people may achieve a response with lithium than with olanzapine (on average, 744 vs 870 per 1000 people; moderate‐certainty evidence), and more withdrawals for any cause may be recorded for patients receiving lithium (low‐certainty evidence). Analysis of remission rates favored lithium, but differences between groups did not reach statistical significance (on average, 905 vs 826 per 1000 people; low‐certainty evidence). Little or no difference in adverse effects was found between groups.High‐certainty evidence indicates that more people achieve response and remission with lithium than with topiramate (on average, 458 vs 270 and 414 vs 240 per 1000 people, respectively). Little or no difference between groups was found in withdrawals for any cause.For comparison of lithium versus antipsychotics, please see CCA 2752.