Has the Effectiveness of Lithium Changed? Impact of the Variety of Lithium's Effects

Grof, Paul

doi:10.1016/s0893-133x(98)00023-2

Cited by 43 publications

(30 citation statements)

References 32 publications

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“…Under lithium: vertigo, nausea and headache (1), acne and weight gain (1), disturbances of potency (1). 2 Discontinuation by the physician because of long-term need of concomitant medication. 3 Pregnancy (2 patients) and change of diagnosis (1).…”

Section: Bipolar I Versus Bipolar Ii/not Otherwise Specifiedmentioning

confidence: 99%

“…The diagnostic criteria for affective disorders have become broader and more differentiated over the last decades. For example, patients who present both manic and schizophrenic symptoms are more readily ascribed to the bipolar disorders as compared to the time when lithium was introduced as prophylactic agent [1][2][3]. This trend towards the broadening and subclassifying of diagnostic categories is fostered by modern research which pays more attention to mixed states, rapid cycling and subsyndromal affective states [3][4][5][6][7][8].…”

mentioning

confidence: 99%

“…It is unclear whether lithium, which was proven to be efficacious for quite a specific disorder covers the whole spectrum of bipolarity. There is some evidence that this is not the case, and that alternative treatments are needed [2,[9][10][11].…”

mentioning

confidence: 99%

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Differential Efficacy of Lithium and Carbamazepine in the Prophylaxis of Bipolar Disorder: Results of the MAP Study

Kleindienst¹,

Greil

2000

Neuropsychobiology

105

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In a randomized clinical trial with an observation period of 2.5 years, the differential efficacy of lithium versus carbamazepine was compared in 171 bipolar patients (DSM-IV). In order to investigate the efficacy of the two drugs in clearly defined subsamples, a series of subgroup analyses was carried out. First, patients with a bipolar I disorder (n = 114) were analyzed separately. In these patients, lithium was superior to carbamazepine. In contrast, carbamazepine was at least equally as efficacious as lithium in the subsample of patients with bipolar II disorder or bipolar disorder not otherwise specified (n = 57). In a second analysis on differential efficacy, the whole sample was subdivided into a classical subgroup (bipolar I patients without mood-incongruent delusions and without comorbidity; n = 67) and a nonclassical subgroup including all other patients (n = 104). Classical bipolar patients had a significantly lower hospitalization rate under lithium than under carbamazepine prophylaxis (26 vs. 62%, p = 0.012). For the nonclassical group, a tendency in favor of carbamazepine was found. In a third step, we analyzed the impact of episode sequence on differential efficacy. In a global view, the episode sequence prior to the index episode was not correlated to differential efficacy. Our results might, however, indicate that patients with an episode sequence of mania-depression-free interval responded better to lithium. Besides differential efficacy, suicidal behavior and patients’ satisfaction with treatment were investigated. Regarding suicidal behavior, a trend in favor of lithium was found. The data on patients’ satisfaction were significantly in favor of carbamazepine. In conclusion, lithium appears to be superior to carbamazepine in classical bipolar cases and might have additional impact on proneness to suicide. The distinctly larger group of patients with nonclassical features might profit more from carbamazepine which seems to be well accepted by the patients. Hence, treatment alternatives to lithium are desirable for the majority of bipolar patients.

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Section: Bipolar I Versus Bipolar Ii/not Otherwise Specifiedmentioning

confidence: 99%

mentioning

confidence: 99%

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Differential Efficacy of Lithium and Carbamazepine in the Prophylaxis of Bipolar Disorder: Results of the MAP Study

Kleindienst¹,

Greil

2000

Neuropsychobiology

105

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“…Grof et al [20][21][22] have studied the differential effects of lithium since the early 80s. They emphasized on various occasions that lithium response is reliably predictable in patients with typical bipolar illness.…”

Section: Discussionmentioning

confidence: 99%

Is There a Loss of Efficacy of Lithium in Patients Treated for Over 20 Years?

Berghöfer

Müller‐Oerlinghausen²

2000

Neuropsychobiology

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Diminishing efficacy of lithium prophylaxis in initially well-responding patients during long-term treatment as well as after interruption of prophylaxis has been described repeatedly in the past. For the present analysis, 22 patients with bipolar and unipolar affective disorder continuously treated and documented in a specialized lithium outpatient clinic over at least 20 years were included. The cumulative affective morbidity of the first 10 years versus the second 10 years of prophylactic treatment was subjected to statistical and single-case (life chart method) analysis. There was no statistical evidence for diminishing efficacy of lithium prophylaxis. The increase in the Morbidity Index in single patients in a case-related individual approach could be revealed as not necessarily due to an alleged loss of efficacy of lithium, but more likely to be due to the atypical features in the psychopathology and course of illness.

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“…Um estudo randomizado de 2,5 anos sobre tratamento de manutenção em pacientes com transtorno afetivo maior mostrou significativamente menos tentativas de suicídio e suicídios no grupo com lítio, em comparação ao grupo com carbamazepina (Thies-Flechtner et al, 1996). Além disso, achados clíni-cos sugerem que a propriedade anti-suicida do lítio atue independentemente de seu efeito preventivo "clássico" nos episódios (Schou, 1997;Bocchetta et al, 1998;Grof, Abreviações: CBZ = carbamazepina, TM = tratamento de manutenção, Li = lítio; *Eletroconvulsoterapia (ECT) de manutenção é uma opção para pacientes que respondam à ECT no tratamento de fase aguda ou que deixem de responder a dois ou mais tratamentos de manutenção com medicamentos. ** Também pode ser considerado um período a mais de psicoterapia.…”

Section: Lítiounclassified

Diretrizes da World Federation of Societies of Biological Psychiatry (WFSBP) para tratamento biológico de transtornos depressivos unipolares, 2ª parte: tratamento de manutenção do transtorno depressivo maior e tratamento dos transtornos depressivos crônicos e das depressões subliminares

Bauer¹,

Whybrow²,

Angst³

et al. 2009

Rev. psiquiatr. clín.

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Has the Effectiveness of Lithium Changed? Impact of the Variety of Lithium's Effects

Cited by 43 publications

References 32 publications

Differential Efficacy of Lithium and Carbamazepine in the Prophylaxis of Bipolar Disorder: Results of the MAP Study

Differential Efficacy of Lithium and Carbamazepine in the Prophylaxis of Bipolar Disorder: Results of the MAP Study

Is There a Loss of Efficacy of Lithium in Patients Treated for Over 20 Years?

Diretrizes da World Federation of Societies of Biological Psychiatry (WFSBP) para tratamento biológico de transtornos depressivos unipolares, 2ª parte: tratamento de manutenção do transtorno depressivo maior e tratamento dos transtornos depressivos crônicos e das depressões subliminares

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