Cochrane · systematic review · CD004048
Lithium for acute mania
McKnight, RF, de La Motte de Broöns de Vauvert, SJ, Chesney, E, et al. · Cochrane Database of Systematic Reviews · 2019 · Cochrane Library
Common Mental DisordersAMSTAR 2: not assessed
SoF tableOnly the outcomes this review put in its Summary of Findings table are listed (the Cochrane Handbook caps them at about seven per comparison). Its other analyses are not shown here.
Questions
82
current version
GRADE rated
54
No studies
28
Included studies
NR
No studies 28 · 34.1%Ungraded 0 · 0%Very low 10 · 12.2%Low 13 · 15.9%Moderate 18 · 22%High 13 · 15.9%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
Questions and results
Lithium compared to placebo for acute mania
Population: acute mania
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Efficacy: response (categorical) YMRS/MRS decrease by ≥ 50% at end of study Lithium vs placebo | OR 2.13 [1.73, 2.63] | 6 studies · 1707 participants | High |
Efficacy: response (continuous) YMRS change from baseline at end of study Lithium vs placebo | no estimate extracted | 4 studies · 935 participants | High |
Efficacy: remission (categorical) YMRS < 12 at end of study Lithium vs placebo | OR 2.16 [1.73, 2.69] | 5 studies · 1597 participants | High |
Acceptability: total withdrawals Lithium vs placebo | OR 0.76 [0.46, 1.25] | 7 studies · 1353 participants | Moderate Downgraded: imprecision |
Adverse event: tremor Lithium vs placebo | OR 3.25 [2.1, 5.04] | 6 studies · 1241 participants | High |
Adverse event: somnolence Lithium vs placebo | OR 2.28 [1.46, 3.58] | 7 studies · 1351 participants | High |
Adverse event: weight gain Lithium vs placebo | OR 1.48 [0.56, 3.92] | 3 studies · 735 participants | Moderate Downgraded: imprecision |
Lithium compared to valproate for acute mania
Population: acute mania
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Efficacy: response (categorical) YMRS/SADS‐C decrease ≥ 50% by end of study Lithium vs valproate | OR 1.22 [0.87, 1.7] | 5 studies · 607 participants | Moderate Downgraded: imprecision |
Efficacy: response (continuous) Change in YMRS (ITT‐LOCF) from baseline to end of study Lithium vs valproate | no estimate extracted | 5 studies · 398 participants | Very low Downgraded: imprecision, inconsistency |
Efficacy: remission (categorical) YMRS ≤ 12 and no increase in MADRS at end of study Lithium vs valproate | OR 0.78 [0.46, 1.32] | 1 study · 257 participants | Moderate Downgraded: imprecision |
Acceptability: total withdrawals Lithium vs valproate | OR 1.2 [0.86, 1.69] | 5 studies · 629 participants | High |
Adverse event: tremor Lithium vs valproate | OR 10.51 [1.96, 56.48] | 2 studies · 449 participants | High |
Adverse event: somnolence Lithium vs valproate | OR 0.47 [0.29, 0.76] | 4 studies · 575 participants | High |
Adverse event: nausea Lithium vs valproate | OR 1.53 [0.97, 2.4] | 4 studies · 583 participants | Moderate Downgraded: imprecision |
Lithium compared to lamotrigine for acute mania
Population: acute mania
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Efficacy: response (categorical) YMRS/SADS‐C decrease ≥ 50% by end of study Lithium vs lamotrigine | no estimate extracted | NR | No studies |
Efficacy: response (continuous) Change in BPRS from baseline to end of study Lithium vs lamotrigine | no estimate extracted | 3 studies · 301 participants | Moderate Downgraded: imprecision |
Efficacy: remission (categorical) YMRS ≤ 12 and no increase in MADRS at end of study Lithium vs lamotrigine | no estimate extracted | NR | No studies |
Acceptability: total withdrawals Lithium vs lamotrigine | OR 0.8 [0.5, 1.29] | 3 studies · 303 participants | Very low Downgraded: imprecision, inconsistency |
Adverse event: tremor Lithium vs lamotrigine | OR 1.28 [0.48, 3.41] | 2 studies · 272 participants | Moderate Downgraded: imprecision |
Adverse event: somnolence Lithium vs lamotrigine | OR 1.14 [0.34, 3.85] | 2 studies · 272 participants | Moderate Downgraded: imprecision |
Lithium compared to carbamazepine for acute mania
Population: acute mania
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Efficacy: response (categorical) YMRS/SADS‐C decrease ≥ 50% by end of study Lithium vs carbamazepine | no estimate extracted | NR | No studies |
Efficacy: response (continuous) YMRS/BPRS change from baseline to end of study Lithium vs carbamazepine | no estimate extracted | 3 studies · 102 participants | Very low Downgraded: risk of bias, imprecision |
Efficacy: response (continuous) CGI change from baseline to end of study Lithium vs carbamazepine | no estimate extracted | 2 studies · 76 participants | Moderate Downgraded: risk of bias |
Efficacy: remission (categorical) YMRS ≤ 12 and no increase in MADRS at end of study Lithium vs carbamazepine | no estimate extracted | NR | No studies |
Acceptability: total withdrawals Lithium vs carbamazepine | OR 0.2 [0.02, 1.94] | 1 study · 34 participants | Low Downgraded: imprecision |
Adverse event: sedation Lithium vs carbamazepine | OR 0.16 [0.01, 3.64] | 1 study · 27 participants | Low Downgraded: risk of bias |
Lithium compared to quetiapine for acute mania
Population: acute mania
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Efficacy: response (categorical) YMRS decrease by ≥ 50% by end of study Lithium vs quetiapine | OR 0.66 [0.28, 1.55] | 2 studies · 335 participants | Very low Downgraded: imprecision, inconsistency, publication bias |
Efficacy: response (continuous) YMRS change from baseline to end of study Lithium vs quetiapine | no estimate extracted | 2 studies · 359 participants | Low Downgraded: inconsistency, publication bias |
Efficacy: remission (categorical) Decrease in YMRS ≤ 12 by end of study Lithium vs quetiapine | OR 0.64 [0.26, 1.57] | 2 studies · 359 participants | Low Downgraded: inconsistency, publication bias |
Acceptability: total withdrawals Lithium vs quetiapine | OR 1.38 [0.83, 2.28] | 2 studies · 359 participants | Very low Downgraded: imprecision, inconsistency, publication bias |
Adverse events Lithium vs quetiapine | no estimate extracted | NR | No studies |
Lithium compared to olanzapine for acute mania
Population: acute mania
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Efficacy: response (categorical) MSRS/YMRS ≥ 50% decrease in score by end of study Lithium vs olanzapine | OR 0.44 [0.2, 0.94] | 2 studies · 180 participants | Moderate Downgraded: publication bias |
Efficacy: response (continuous) CGI severity score at end of study Lithium vs olanzapine | no estimate extracted | 3 studies · 210 participants | Low Downgraded: risk of bias, publication bias |
Efficacy: remission (categorical) YMRS ≤ 12 at end of study Lithium vs olanzapine | OR 2 [0.89, 4.46] | 1 study · 140 participants | Low Downgraded: imprecision, publication bias |
Acceptability: total withdrawals Lithium vs olanzapine | OR 2.6 [1.13, 5.99] | 3 studies · 210 participants | Low Downgraded: imprecision, publication bias |
Adverse events Lithium vs olanzapine | no estimate extracted | NR | No studies |
Lithium compared to chlorpromazine for acute mania
Population: acute mania
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Efficacy: response (categorical) MSRS/YMRS ≥ 50% decrease in score by end of study Lithium vs chlorpromazine | no estimate extracted | NR | No studies |
Efficacy: response (continuous) BPRS score change from baseline to end of study Lithium vs chlorpromazine | no estimate extracted | 2 studies · 284 participants | Very low Downgraded: risk of bias, inconsistency, publication bias |
Efficacy: remission (categorical) YMRS ≤ 12 at end of study Lithium vs chlorpromazine | no estimate extracted | NR | No studies |
Acceptability: total withdrawals Lithium vs chlorpromazine | OR 1.75 [0.92, 3.31] | 2 studies · 262 participants | Low Downgraded: risk of bias, publication bias |
Adverse events Lithium vs chlorpromazine | no estimate extracted | NR | No studies |
Lithium compared to haloperidol for acute mania
Population: acute mania
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Efficacy: response (categorical) MSRS/YMRS ≥ 50% decrease in score by end of study Lithium vs haloperidol | no estimate extracted | NR | No studies |
Efficacy: response (continuous) change in BPRS (total) from baseline to end of study ‐all data Lithium vs haloperidol | no estimate extracted | 3 studies · 80 participants | Very low Downgraded: risk of bias, inconsistency |
Efficacy: remission (categorical) YMRS ≤ 12 at end of study Lithium vs haloperidol | no estimate extracted | NR | No studies |
Acceptability: total withdrawals Lithium vs haloperidol | OR 0.29 [0.03, 3.12] | 1 study · 30 participants | Very low Downgraded: imprecision, publication bias |
Adverse events Lithium vs haloperidol | no estimate extracted | NR | No studies |
Lithium compared to zuclopenthixol for acute mania
Population: acute mania
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Efficacy: response (categorical) BMRS change ≥ 50% from baseline to end of study Lithium vs zuclopenthixol | OR 1.33 [0.3, 5.91] | 1 study · 28 participants | Very low Downgraded: risk of bias, imprecision, publication bias |
Efficacy: response (continuous) change in BPRS (total) from baseline to end of study ‐all data Lithium vs zuclopenthixol | no estimate extracted | NR | No studies |
Efficacy: remission (categorical) YMRS ≤ 12 at end of study Lithium vs zuclopenthixol | no estimate extracted | NR | No studies |
Acceptability: total withdrawals Lithium vs zuclopenthixol | OR 0.78 [0.17, 3.49] | 1 study · 28 participants | Very low Downgraded: risk of bias, imprecision, publication bias |
Adverse events Lithium vs zuclopenthixol | no estimate extracted | NR | No studies |
Lithium compared to risperidone for acute mania
Population: acute mania
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Efficacy: response (categorical) BMRS change ≥ 50% from baseline to end of study Lithium vs risperidone | no estimate extracted | NR | No studies |
Efficacy: response (continuous) YMRS/MRS change at the end of the study Lithium vs risperidone | no estimate extracted | 3 studies · 241 participants | Low Downgraded: imprecision, publication bias |
Efficacy: remission (categorical) YMRS ≤ 12/absence of DSM‐IV mania by end of study Lithium vs risperidone | OR 1.3 [0.11, 14.95] | 2 studies · 211 participants | Low Downgraded: imprecision, publication bias |
Acceptability: total withdrawals Lithium vs risperidone | OR 1.85 [1.02, 3.34] | 3 studies · 255 participants | Moderate Downgraded: publication bias |
Adverse events: drowsiness/ somnolence Lithium vs risperidone | OR 0.43 [0.24, 0.75] | 2 studies · 219 participants | Moderate Downgraded: publication bias |
Lithium compared to aripiprazole for acute mania
Population: acute mania
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Efficacy: response (categorical) BMRS change ≥ 50% from baseline to end of study Lithium vs aripiprazole | no estimate extracted | NR | No studies |
Efficacy: response (continuous) YMRS change by ≥ 50% at end of study Lithium vs aripiprazole | OR 0.96 [0.62, 1.51] | 1 study · 309 participants | Moderate Downgraded: publication bias |
Efficacy: remission (categorical) YMRS ≤ 12 at end of study Lithium vs aripiprazole | OR 0.99 [0.63, 1.56] | 1 study · 309 participants | Moderate Downgraded: publication bias |
Acceptability: total withdrawals Lithium vs aripiprazole | OR 0.94 [0.6, 1.46] | 1 study · 315 participants | Moderate Downgraded: publication bias |
Adverse events: tremor Lithium vs aripiprazole | OR 1.45 [0.65, 3.24] | 1 study · 313 participants | Moderate Downgraded: publication bias |
Adverse events: somnolence/sedation Lithium vs aripiprazole | OR 0.56 [0.26, 1.23] | 1 study · 313 participants | Moderate Downgraded: publication bias |
Adverse events: clinically relevant (> 7%) weight gain Lithium vs aripiprazole | OR 2.07 [0.18, 23.21] | 1 study · 184 participants | Low Downgraded: imprecision, publication bias |
Lithium compared to topiramate for acute mania
Population: acute mania
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Efficacy: response (categorical) YMRS change ≥ 50% from baseline to end of study Lithium vs topiramate | OR 2.28 [1.63, 3.2] | 1 study · 660 participants | High |
Efficacy: response (continuous) YMRS change by ≥ 50% at end of study Lithium vs topiramate | no estimate extracted | NR | No studies |
Efficacy: remission (categorical) YMRS ≤ 12 at end of study Lithium vs topiramate | OR 2.24 [1.58, 3.15] | 1 study · 660 participants | High |
Acceptability: total withdrawals Lithium vs topiramate | OR 1.28 [0.66, 2.48] | 2 studies · 1352 participants | High |
Lithium compared to clonazepam for acute mania
Population: acute mania
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Efficacy: response (categorical) YMRS change ≥ 50% from baseline to end of study Lithium vs clonazepam | no estimate extracted | NR | No studies |
Efficacy: response (continuous) change in CGI score from baseline to end of study Lithium vs clonazepam | no estimate extracted | 2 studies · 41 participants | Moderate Downgraded: risk of bias |
Efficacy : remission (categorical) YMRS ≤ 12 at end of study Lithium vs clonazepam | no estimate extracted | NR | No studies |
Acceptability: total withdrawals Lithium vs clonazepam | no estimate extracted | NR | No studies |
Adverse events Lithium vs clonazepam | no estimate extracted | NR | No studies |
Lithium compared to electroconvulsive therapy (ECT) for acute mania
Population: acute mania
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Efficacy: response (categorical) YMRS change ≥ 50% from baseline to end of study Lithium vs electroconvulsive therapy (ECT) | no estimate extracted | NR | No studies |
Efficacy: response (continuous) MRS mean change from baseline to end of study Lithium vs electroconvulsive therapy (ECT) | no estimate extracted | 1 study · 34 participants | Low Downgraded: imprecision, publication bias |
Efficacy: remission (categorical) YMRS ≤ 12 at end of study Lithium vs electroconvulsive therapy (ECT) | no estimate extracted | NR | No studies |
Acceptability: total withdrawals Lithium vs electroconvulsive therapy (ECT) | no estimate extracted | NR | No studies |
Adverse events Lithium vs electroconvulsive therapy (ECT) | no estimate extracted | NR | No studies |
Lithium compared to all antimanic agents for acute mania
Population: acute mania
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Efficacy: response (categorical) YMRS/MRS/BPRS change by ≥ 50% at end of study Lithium vs all antimanic agents | OR 1.36 [1.01, 1.83] | 14 studies · 3666 participants | High |
Efficacy: response (continuous) YMRS/BPRS: change from baseline to end of study Lithium vs all antimanic agents | no estimate extracted | 19 studies · 2410 participants | Low Downgraded: imprecision, inconsistency |
Efficacy: remission (categorical) YMRS ≤ 12 at end of study Lithium vs all antimanic agents | no estimate extracted | NR | No studies |
Acceptability: total withdrawals Lithium vs all antimanic agents | OR 1.16 [0.89, 1.52] | 24 studies · 4201 participants | High |
Adverse events Lithium vs all antimanic agents | no estimate extracted | NR | No studies |