What do systematic reviews say?

Lithium vs valproate

Lithium showed no clear difference in efficacy: remission (categorical) YMRS ≤ 12 and no increase in MADRS… compared with valproate (moderate certainty).

• Lithium for acute mania 2019 · Cochrane Headline outcomes only
  OR 0.78 [0.46, 1.32]
  1 study · 257 participants
  Moderate

Lithium vs valproate

Lithium showed no clear difference in acceptability: total withdrawals compared with valproate (high certainty).

• Lithium for acute mania 2019 · Cochrane Headline outcomes only
  OR 1.2 [0.86, 1.69]
  5 studies · 629 participants
  High

Lithium vs valproate

Lithium leads to higher adverse event: tremor compared with valproate (high certainty).

• Lithium for acute mania 2019 · Cochrane Headline outcomes only
  OR 10.51 [1.96, 56.48]
  2 studies · 449 participants
  High

Lithium vs valproate

Lithium leads to lower adverse event: somnolence compared with valproate (high certainty).

• Lithium for acute mania 2019 · Cochrane Headline outcomes only
  OR 0.47 [0.29, 0.76]
  4 studies · 575 participants
  High

Lithium vs valproate

Lithium showed no clear difference in adverse event: nausea compared with valproate (moderate certainty).

• Lithium for acute mania 2019 · Cochrane Headline outcomes only
  OR 1.53 [0.97, 2.4]
  4 studies · 583 participants
  Moderate

Lithium vs valproate

Lithium showed no clear difference in efficacy: response (categorical) YMRS/SADS‐C decrease ≥ 50% by end… compared with valproate (moderate certainty).

• Lithium for acute mania 2019 · Cochrane Headline outcomes only
  OR 1.22 [0.87, 1.7]
  5 studies · 607 participants
  Moderate

Lithium vs valproate

• Lithium for acute mania 2019 · Cochrane Headline outcomes only
  no estimate extracted
  5 studies · 398 participants
  Very low