How does lithium compare with antipsychotics for people with acute mania?

CIAPPONI, AGUSTÍN

Cochrane Clinical Answers

Cochrane Clinical Answers

Año: 2019

Lithium may be less likely than risperidone to induce a response, drowsiness/somnolence, or weight gain in adults and children with acute mania, and may result in an increase in withdrawals, gastrointestinal adverse effects, and dry mouth. There are probably no important differences in outcomes when lithium is compared with aripiprazole, and the effect when compared with other antipsychotics is uncertain.For adults with acute mania, there was little or no difference in response rates between lithium and chlorpromazine. More people may withdraw from treatment for any cause with lithium (on average, 231 vs 146 per 1000 people; low‐certainty evidence), and there was little or no difference in adverse effects between groups.When lithium is compared with risperidone, risperidone may be more effective in reducing manic symptoms (mean difference, around 7 points on a scale from 0 to 56; low‐certainty evidence) and it was reported that fewer people taking risperidone withdrew from treatment (on average, 256 vs 157 per 1000 people; moderate‐certainty evidence). More people may experience remission (on average, 688 vs 629 per 1000 people); however, this difference did not reach statistical significance, so the effect is imprecise (low‐certainty evidence). Lithium was associated with higher rates of most adverse events apart from drowsiness/somnolence.Moderate‐certainty evidence shows that there is probably no important difference in response, remission, or withdrawals for any cause when lithium is compared with aripiprazole (on average, 458 vs 468, 400 vs 403, and 513 vs 529 per 1000 people, respectively) nor on the rate of adverse effects.The effect of haloperidol or zuclopenthixol compared with lithium is uncertain.For comparison of lithium versus mood stabilizers, please see CCA 2753.