Magazine article Clinical Psychiatry News

Lithium Decline Reflects Economic, Not Clinical Trends: Since 1965, 24 Studies Have Reported a Drop in Bipolar Recurrence with Lithium. (Valproate Garners 70% of the Market)

Magazine article Clinical Psychiatry News

Lithium Decline Reflects Economic, Not Clinical Trends: Since 1965, 24 Studies Have Reported a Drop in Bipolar Recurrence with Lithium. (Valproate Garners 70% of the Market)

Article excerpt

ATLANTA -- Reports of lithium's demise as an effective drug for bipolar disorder have been greatly exaggerated, Dr. Frederick Goodwin said at the annual meeting of the American Academy of Clinical Psychiatrists.

The perception that the drug "stopped working" in the 199 Os largely reflects changing study populations; the influence of pharmaceutical marketing; and, perhaps, a decline in expertise, said Dr. Goodwin, director of the psychopharmacology research center at George Washington University, Washington.

Although lithium remains the only medication approved by the Food and Drug Administration for maintenance treatment of bipolar disorder, there has been a dramatic shift in prescribing patterns in the United Stares. Valproate now accounts for 70% of the mood stabilizer market, and lithium roughly 25%, he said.

In part, this reflects the belief among clinicians that lithium has become ineffective (according to some reports, it works for just one-third of patients, compared with 75% in the 1970s), and that it is more difficult to use than other mood stabilizers, he said.

Since the 1970s, there has been a substantial broadening in the diagnosis of bipolar disorder that may have affected drug efficacy. More patients have psychotic features, substance abuse comorbidity has risen, and age of onset has declined. More bipolar patients are exposed to antidepressants, which can influence mood stabilizer response.

In general, the longer a successful treatment is available, the more difficult it is to show that it works in clinical trials. As a higher proportion of good responders are treated in private practice, research centers are left with more difficult cases.

In fact, a review of the international literature found no decline in efficacy In 24 studies done between 1965 and 1995, recurrence rates for bipolar patients maintained on lithium actually dropped over the years. "They were five times lower in the 1980s and 1990s than in the 1970s--the reverse of what one might expect," he said.

Twenty-two of these studies were done in Europe, primarily in specialized lithium clinics where physicians have become increasingly skilled in its administration. …

Search by... Author
Show... All Results Primary Sources Peer-reviewed

Oops!

An unknown error has occurred. Please click the button below to reload the page. If the problem persists, please try again in a little while.