Magazine article Clinical Psychiatry News

Lithium Reduces Use of Antipsychotics in Bipolar

Magazine article Clinical Psychiatry News

Lithium Reduces Use of Antipsychotics in Bipolar

Article excerpt


LAS VEGAS - In a 6-month study, the use of adjunctive moderately dosed lithium to optimized treatment in patients with bipolar disorder was well tolerated yet did not lead to improved outcomes or decreased suicidality. However, use of adjunctive lithium resulted in a significant reduction in the use of second-generation antipsychotics.

Those are key findings from the Bipolar Trials Network Lithium Treatment t Moderate Dose Study, a randomized trial that compared the use of lithium plus I optimized treatment with optimized t treatment alone.

"Currently, only about one-third of I bipolar patients take lithium," Dr. Michael E. Thase said during a psychopharmacology conference sponsored t by the Nevada Psychiatric Association. I And outpatients uncommonly take lithium in higher, well-established doses. Today it's more commonly used in moderate doses in combination with newer generation therapies. However, the value of lower dose, combination strategies has not been well studied."

For the outpatient study, known as the Lithium treatment-moderate dose use study, or LiTMUS, and led by Dr. Andrew A. Nierenberg at the Massachusetts General Hospital, investigators at six clinical sites enrolled 283 patients with bipolar I or bipolar II disorder with a Clinical Global Impressions-Bipolar Scale (CGI-BP-S) c, score of 3 or greater to assess whether lithium, in moderate doses, "could be a useful platform upon which other newer treatments could be evaluated," said Dr. Thase, professor of psychiatry at the University of Pennsylvania, Philadelphia.

"We were working in partnership with colleagues at the National Institute of Mental Health to do this study in a real-world, relevant way, meaning that it must be inclusive so that people with common comorbidities needed to be in the study, that it needed to be administered in an open way so that the results would be generalizable," would br generalizable, said Dr. Thase, who also pointed out that there was no placebo control group.

The investigators compared lithium plus optimized treatment or optimized u treatment without lithium. Patients in the lithium arm were started on 300 mg b.i.d. and sustained on 600 mg/ day for 8 weeks, adjusted as needed thereafter. The Texas Implementation of Medication Algorithms for bipolar disorder informed care.

The two main outcomes assessed at 6 months were the CGI-BP-S and the number of Necessary Clinical Adjustments (NCAs), a measure of how difficult treatment was to implement. "This takes into account how many times you had to change the treatment in response to side effects or in response to the treatment not working," Dr. Thase explained. "The higher the NCA count, the stormier the treatment course."

A secondary measure was side effect burden as measured by the Frequency and Intensity of Side Effects Ratings, "which provides composite ratings of tolerability rather than focusing on specific side effects," he said. "These were completed at each study visit by the treating psychiatrist."

Dr. Thase reported that 84% of patients completed the 6 months of treatment, The attrition rate was not significantly different among those who received lithium, compared with those who did not receive the drug. The modal dose of lithium was 600 mg/day, and the average lithium levels ranged between 0. …

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