Mood stabilizers in the prevention of recurrent affective disorders: a meta-analysis.
OBJECTIVE
To determine by meta-analysis the efficacy of mood stabilizers in preventing recurrence of bipolar or unipolar mood disorders and to consider the evidence for a lithium withdrawal-induced relapse syndrome.


METHODS
Controlled studies of lithium, valproate and carbamazepine in preventing future episodes of affective disorders were classified according to methodological rigour, and meta-analyses were performed overall and on each type.


RESULTS
A total of 19 blinded, randomized, controlled trials of prophylaxis in 865 patients found lithium highly effective (74% recurrence on placebo vs. 29% on lithium). In the mirror-image studies, whose substantial lithium vs. prior treatment difference cannot be explained by withdrawal relapse, lithium reduced relapse by 50% (bipolar) and 58%(unipolar).


CONCLUSIONS
Maintenance lithium produces a highly significant reduction in relapses. The mirror-image studies had not been systematically analysed previously, and they support the effectiveness of lithium. We also failed to find sufficient evidence to prove that the lithium-withdrawal relapse phenomenon exists.
Davis
J M
JM
Department of Psychiatry, Psychiatric Institute, University of Illinois at Chicago, 60612, USA.
Janicak
P G
PG
Hogan
D M
DM
D018692:Antimanic Agents / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use*; D002220:Carbamazepine / Q000494:pharmacology / Q000627:therapeutic use*; D006801:Humans; D016651:Lithium Carbonate / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use*; D019964:Mood Disorders / Q000188:drug therapy* / Q000517:prevention & control; D011379:Prognosis; D012008:Recurrence; D013375:Substance Withdrawal Syndrome; D016896:Treatment Outcome; D014635:Valproic Acid / Q000494:pharmacology / Q000627:therapeutic use*
D018692:Antimanic Agents; D016651:Lithium Carbonate; D002220:Carbamazepine; D014635:Valproic Acid