Terence A Ketter1, Shefali Miller2, Bernardo Dell'Osso3, Po W Wang2. 1. Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA. Electronic address: tketter@stanford.edu. 2. Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA. 3. Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA; Department of Psychiatry, University of Milan, Fondazione IRCCS Ca'Granda, Ospedale Maggiore Policlinico, Milan, Italy.
Abstract
BACKGROUND: Lithium, the prototypical mood stabilizer, and quetiapine, a second-generation antipsychotic, are widely used acute and maintenance pharmacotherapies for bipolar disorder. The Clinical and Health Outcomes Initiative in Comparative Effectiveness for Bipolar Disorder (Bipolar CHOICE) study was the first comparative effectiveness assessment of lithium versus quetiapine (in combination with adjunctive personalized treatment), and found no overall significant differences in efficacy and safety/tolerability outcomes between lithium and quetiapine. Completion of Bipolar CHOICE offers a timely opportunity to review the evidence regarding lithium and quetiapine for bipolar disorder. METHODS: Controlled clinical trials and real-world observational studies that included quetiapine and lithium as monotherapy or as combination therapy were identified by literature search. Selected studies were reviewed in detail. RESULTS: Review of the available trials suggested comparable efficacy of quetiapine and lithium in acute mania, and possibly greater efficacy for quetiapine compared with lithium in acute bipolar depression and in prevention of recurrent (particularly depressive) episodes. Combination therapy including quetiapine and lithium was generally more effective than either agent alone in acute mania and bipolar maintenance, although adding lithium to quetiapine did not increase efficacy in acute bipolar depression. Safety data for quetiapine and lithium were consistent with the established profiles of the two treatments. LIMITATIONS: Limitations include those of the available efficacy and effectiveness trial data. CONCLUSIONS: Quetiapine and lithium have overlapping but distinctive roles in different phases of bipolar disorder, and further studies of these agents (particularly in combination with one another) are warranted.
BACKGROUND:Lithium, the prototypical mood stabilizer, and quetiapine, a second-generation antipsychotic, are widely used acute and maintenance pharmacotherapies for bipolar disorder. The Clinical and Health Outcomes Initiative in Comparative Effectiveness for Bipolar Disorder (Bipolar CHOICE) study was the first comparative effectiveness assessment of lithium versus quetiapine (in combination with adjunctive personalized treatment), and found no overall significant differences in efficacy and safety/tolerability outcomes between lithium and quetiapine. Completion of Bipolar CHOICE offers a timely opportunity to review the evidence regarding lithium and quetiapine for bipolar disorder. METHODS: Controlled clinical trials and real-world observational studies that included quetiapine and lithium as monotherapy or as combination therapy were identified by literature search. Selected studies were reviewed in detail. RESULTS: Review of the available trials suggested comparable efficacy of quetiapine and lithium in acute mania, and possibly greater efficacy for quetiapine compared with lithium in acute bipolar depression and in prevention of recurrent (particularly depressive) episodes. Combination therapy including quetiapine and lithium was generally more effective than either agent alone in acute mania and bipolar maintenance, although adding lithium to quetiapine did not increase efficacy in acute bipolar depression. Safety data for quetiapine and lithium were consistent with the established profiles of the two treatments. LIMITATIONS: Limitations include those of the available efficacy and effectiveness trial data. CONCLUSIONS:Quetiapine and lithium have overlapping but distinctive roles in different phases of bipolar disorder, and further studies of these agents (particularly in combination with one another) are warranted.
Authors: Du Lei; Wenbin Li; Maxwell J Tallman; L Rodrigo Patino; Robert K McNamara; Jeffrey R Strawn; Christina C Klein; Fabiano G Nery; David E Fleck; Kun Qin; Yuan Ai; Jing Yang; Wenjing Zhang; Su Lui; Qiyong Gong; Caleb M Adler; John A Sweeney; Melissa P DelBello Journal: Neuropsychopharmacology Date: 2021-03-22 Impact factor: 7.853
Authors: Maurizio Pompili; Ross J Baldessarini; Alberto Forte; Denise Erbuto; Gianluca Serafini; Andrea Fiorillo; Mario Amore; Paolo Girardi Journal: Int J Mol Sci Date: 2016-10-11 Impact factor: 5.923