Prophylactic Efficacy of Lithium Versus Carbamazepine in Treatment-Naive Bipolar Patients
J Clin Psychiatry 2003;64(2):144-151
© Copyright 2014 Physicians Postgraduate Press, Inc.
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Background: Alternatives to lithium for
prophylactic treatment of patients with bipolar affective
disorders are increasingly being advocated. However, trials
comparing lithium with alternatives are scarce and often biased.
Method: We studied 94 patients with at least 2
episodes of bipolar disorder (DSM-III-R) during the previous 3
years who were in remission at entry into the study. Treatment
with lithium or carbamazepine had not exceeded a total of 6
months during their lifetime. Patients were randomly assigned to
carbamazepine or lithium at entry into the 2-year double-blind
study or during the acute index episode previous to entry into
the study. No concurrent antipsychotics or antidepressants were
Results: On lithium treatment, 12/44 patients
developed an episode, compared with 21/50 on carbamazepine
treatment. Episodes on lithium treatment occurred almost
exclusively during the first 3 months of the trial. Carbamazepine
carried a constant risk of an episode of about 40% per year.
Efficacy of lithium was superior to that of carbamazepine in
patients with a (hypo)manic index episode that had not been
treated with study drug during the index episode (p< .05). The proportion of patients who dropped out was
slightly higher among those taking lithium (16/44) compared with
those taking carbamazepine (13/50), resulting in 16/44 patients
(36%) on lithium treatment completing the 2 years with no
episode, compared with 16/50 (32%) on carbamazepine treatment.
Conclusion: Lithium appears to be superior in
prophylactic efficacy to carbamazepine in bipolar patients not
previously treated with mood stabilizers. Our results should
reinforce efforts to put and maintain such patients on treatment