title: Lithium versus carbamazepine in the maintenance treatment of bipolar disorders--a randomised study.
abstract: In a randomised multicentre study, the prophylactic efficacy of lithium and carbamazepine was compared in 144 patients with bipolar disorder (74 vs. 70 patients; observation period: 2.5 years; lithium serum level: 0.63 +/- 0.12 mmol/l, carbamazepine dose: 621 +/- 186 mg/day). Hospitalisations, recurrences, need of psychotropic comedication and adverse effects prompting discontinuation were defined as treatment failures. Survival analyses regarding hospitalisations and recurrences showed no statistically significant differences between both drugs. Results were distinctly in favour of lithium, considering recurrences combined with comedication (P = 0.041) and/or adverse effects (P = 0.007). Whereas adverse effects prompting discontinuation were more frequent under carbamazepine (9 vs. 4, ns), lithium patients reported more often slight/moderate side effects (61% vs. 21% after 2.5 years; P = 0.0006). In completers, recurrences occurred in 28% (lithium) vs. 47% (carbamazepine) of the patients (P = 0.06). Lithium seems to be superior to carbamazepine in maintenance treatment of bipolar disorder, in particular when applying broader outcome criteria including psychotropic comedication and severe side effects.
authors.affiliation: Psychiatric Hospital, University of Munich, Germany.
authors.forename: W
authors.initials: W
authors.lastname: Greil
authors.forename: W
authors.initials: W
authors.lastname: Ludwig-Mayerhofer
authors.forename: N
authors.initials: N
authors.lastname: Erazo
authors.forename: C
authors.initials: C
authors.lastname: Schöchlin
authors.forename: S
authors.initials: S
authors.lastname: Schmidt
authors.forename: R R
authors.initials: RR
authors.lastname: Engel
authors.forename: A
authors.initials: A
authors.lastname: Czernik
authors.forename: H
authors.initials: H
authors.lastname: Giedke
authors.forename: B
authors.initials: B
authors.lastname: Müller-Oerlinghausen
authors.forename: M
authors.initials: M
authors.lastname: Osterheider
authors.forename: G A
authors.initials: GA
authors.lastname: Rudolf
authors.forename: H
authors.initials: H
authors.lastname: Sauer
authors.forename: J
authors.initials: J
authors.lastname: Tegeler
authors.forename: T
authors.initials: T
authors.lastname: Wetterling
mesh_terms: D000328:Adult; D000928:Antidepressive Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001714:Bipolar Disorder / Q000188:drug therapy*; D002220:Carbamazepine / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D016651:Lithium Carbonate / Q000009:adverse effects / Q000627:therapeutic use*; D008297:Male
chemical_list: D000928:Antidepressive Agents; D016651:Lithium Carbonate; D002220:Carbamazepine