BACKGROUND: Clinicians frequently use lithium to augment antipsychotic medication in schizophrenia. Therefore, we undertook a systematic review and meta-analysis of the use of lithium in the treatment of schizophrenia. DATA SOURCES AND STUDY SELECTION: Randomized controlled trials examining lithium (as a sole or an adjunctive compound) in participants with schizophrenia or related disorders were searched in the register of the Cochrane Schizophrenia Group. No language restrictions were applied. The Boolean phrase [lithium* or lithicarb or eskalith or lithobid or lithane or cibalith-s or quilonum or hypnorex] was used to locate articles. The search strategy initially identified 90 references. The authors of the included studies were contacted to obtain original patient data. The data were combined in a meta-analysis. The main outcome parameters were the number of patients with a clinically significant response and the number of patients leaving the studies early. RESULTS: The meta-analysis includes 20 studies (N = 611). The evidence shows that lithium as a sole agent is ineffective in the treatment of schizophrenia. Eleven trials examined the augmentation of antipsychotics with lithium. More patients who received lithium augmentation than those who received antipsychotics alone were classified as responders. However, the superiority was not consistent across different response thresholds, and when patients with prominent affective symptoms were excluded from the analysis, the advantage of lithium augmentation was not significant (p =.07). Significantly more patients taking lithium left the trials early, suggesting a lower acceptability of lithium augmentation compared with that of taking antipsychotics alone. CONCLUSION: Despite some evidence in favor of lithium augmentation, the overall results are inconclusive. A large trial of lithium augmentation of antipsychotic medications will be required in order to detect a benefit of small effect size in patients with schizophrenia who lack affective symptoms.
BACKGROUND: Clinicians frequently use lithium to augment antipsychotic medication in schizophrenia. Therefore, we undertook a systematic review and meta-analysis of the use of lithium in the treatment of schizophrenia. DATA SOURCES AND STUDY SELECTION: Randomized controlled trials examining lithium (as a sole or an adjunctive compound) in participants with schizophrenia or related disorders were searched in the register of the Cochrane Schizophrenia Group. No language restrictions were applied. The Boolean phrase [lithium* or lithicarb or eskalith or lithobid or lithane or cibalith-s or quilonum or hypnorex] was used to locate articles. The search strategy initially identified 90 references. The authors of the included studies were contacted to obtain original patient data. The data were combined in a meta-analysis. The main outcome parameters were the number of patients with a clinically significant response and the number of patients leaving the studies early. RESULTS: The meta-analysis includes 20 studies (N = 611). The evidence shows that lithium as a sole agent is ineffective in the treatment of schizophrenia. Eleven trials examined the augmentation of antipsychotics with lithium. More patients who received lithium augmentation than those who received antipsychotics alone were classified as responders. However, the superiority was not consistent across different response thresholds, and when patients with prominent affective symptoms were excluded from the analysis, the advantage of lithium augmentation was not significant (p =.07). Significantly more patients taking lithium left the trials early, suggesting a lower acceptability of lithium augmentation compared with that of taking antipsychotics alone. CONCLUSION: Despite some evidence in favor of lithium augmentation, the overall results are inconclusive. A large trial of lithium augmentation of antipsychotic medications will be required in order to detect a benefit of small effect size in patients with schizophrenia who lack affective symptoms.
Authors: Jen Q Pan; Michael C Lewis; Josh K Ketterman; Elizabeth L Clore; Misha Riley; Keenan R Richards; Erin Berry-Scott; Xiulin Liu; Florence F Wagner; Edward B Holson; Rachael L Neve; Travis L Biechele; Randall T Moon; Edward M Scolnick; Tracey L Petryshen; Stephen J Haggarty Journal: Neuropsychopharmacology Date: 2011-03-09 Impact factor: 7.853
Authors: David Pritchett; Katharina Wulff; Peter L Oliver; David M Bannerman; Kay E Davies; Paul J Harrison; Stuart N Peirson; Russell G Foster Journal: J Neural Transm (Vienna) Date: 2012-05-10 Impact factor: 3.575
Authors: Konstantinos N Fountoulakis; Elena Dragioti; Antonis T Theofilidis; Tobias Wikilund; Xenofon Atmatzidis; Ioannis Nimatoudis; Erik Thys; Martien Wampers; Luchezar Hranov; Trayana Hristova; Daniil Aptalidis; Roumen Milev; Felicia Iftene; Filip Spaniel; Pavel Knytl; Petra Furstova; Tiina From; Henry Karlsson; Maija Walta; Raimo K R Salokangas; Jean-Michel Azorin; Justine Bouniard; Julie Montant; Georg Juckel; Ida S Haussleiter; Athanasios Douzenis; Ioannis Michopoulos; Panagiotis Ferentinos; Nikolaos Smyrnis; Leonidas Mantonakis; Zsófia Nemes; Xenia Gonda; Dora Vajda; Anita Juhasz; Amresh Shrivastava; John Waddington; Maurizio Pompili; Anna Comparelli; Valentina Corigliano; Elmars Rancans; Alvydas Navickas; Jan Hilbig; Laurynas Bukelskis; Lidija Injac Stevovic; Sanja Vodopic; Oluyomi Esan; Oluremi Oladele; Christopher Osunbote; Janusz Κ Rybakowski; Pawel Wojciak; Klaudia Domowicz; Maria Luisa Figueira; Ludgero Linhares; Joana Crawford; Anca-Livia Panfil; Daria Smirnova; Olga Izmailova; Dusica Lecic-Tosevski; Henk Temmingh; Fleur Howells; Julio Bobes; Maria Paz Garcia-Portilla; Leticia García-Alvarez; Gamze Erzin; Hasan Karadağ; Avinash De Sousa; Anuja Bendre; Cyril Hoschl; Cristina Bredicean; Ion Papava; Olivera Vukovic; Bojana Pejuskovic; Vincent Russell; Loukas Athanasiadis; Anastasia Konsta; Dan Stein; Michael Berk; Olivia Dean; Rajiv Tandon; Siegfried Kasper; Marc De Hert Journal: Int J Neuropsychopharmacol Date: 2019-11-01 Impact factor: 5.176