| Is the prophylactic antidepressant efficacy of lithium in bipolar I disorder dependent on study design and lithium level? | |
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MedLine Citation:
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PMID: 16160621 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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In the 1970s, several randomized controlled trials demonstrated significant antimanic and antidepressant properties of lithium in the prophylactic treatment of bipolar disorder. However, a recent meta-analysis of randomized, placebo-controlled trials of lithium in bipolar disorder found that its protective effect against depressive relapse/recurrence was equivocal. By examining potentially relevant parameters of recent randomized controlled trials with regard to lithium's prophylactic antidepressant efficacy, we try to identify factors which might help to explain these discrepant results across the different trials. Lithium's efficacy against manic relapse/recurrence appears rather robust at plasma levels between 0.8 and 1.2 mmol/L, whereas lithium's efficacy against depressive relapse/recurrence may be more modest and dependent on whether a response during the preceding acute episode was achieved by lithium treatment. Furthermore, it might be advisable to continue lithium without interruption at the same dose/plasma level, which yielded the initial response. A lithium level between 0.5 and 0.8 mmol/L may be equally efficacious against overall relapse and associated with equal or even superior efficacy regarding depressive relapse/recurrence. To provide evidence-based guidelines on this issue, large prospective, randomized, double-blind, placebo-controlled trials are needed comparing the efficacy of lithium at different plasma levels against manic and depressive relapse/recurrence. In these trials, factors previously associated with predicting response to lithium should also be assessed. |
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Authors:
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Wolfram Emanuel Severus; Heinz Grunze; Nikolaus Kleindienst; Sophia Frangou; Hans-Juergen Moeller |
Publication Detail:
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Type: Journal Article; Meta-Analysis; Review |
Journal Detail:
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Title: Journal of clinical psychopharmacology Volume: 25 ISSN: 0271-0749 ISO Abbreviation: J Clin Psychopharmacol Publication Date: 2005 Oct |
Date Detail:
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Created Date: 2005-09-14 Completed Date: 2005-11-30 Revised Date: 2007-11-15 |
Medline Journal Info:
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Nlm Unique ID: 8109496 Medline TA: J Clin Psychopharmacol Country: United States |
Other Details:
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Languages: eng Pagination: 457-62 Citation Subset: IM |
Affiliation:
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Department of Psychiatry, University of Munich, Germany. Emanuel.Severus@med.uni-muenchen.de |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Antidepressive Agents
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blood*,
therapeutic use* Antimanic Agents / therapeutic use Bipolar Disorder / prevention & control*, psychology Double-Blind Method Humans Lithium / blood*, therapeutic use* Randomized Controlled Trials as Topic Research Design Triazines / therapeutic use |
| Chemical | |
Reg. No./Substance:
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0/Antidepressive Agents; 0/Antimanic Agents; 0/Triazines; 7439-93-2/Lithium; 84057-84-1/lamotrigine |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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