title: An exploratory study of responses to low-dose lithium in African Americans and Hispanics.
abstract: OBJECTIVE
  Few prospective studies examine the impact of ethnicity or race on outcomes with lithium for bipolar disorder. This exploratory study examines differences in lithium response and treatment outcomes in Hispanics, African Americans, and non-Hispanic whites with bipolar disorder in the Lithium Treatment Moderate Dose Use Study (LiTMUS).
  
  
  METHODS
  LiTMUS was a six-site randomized controlled trial of low-dose lithium added to optimized treatment (OPT; personalized, evidence-based pharmacotherapy) vs. OPT alone in outpatients with bipolar disorder. Of 283 participants, 47 African Americans, 39 Hispanics, and 175 non-Hispanic whites were examined. We predicted minority groups would have more negative medication attitudes and higher attrition rates, but better clinical outcomes.
  
  
  RESULTS
  African Americans in the lithium group improved more on depression and life functioning compared to whites over the 6 month study. African Americans in the OPT only group had marginal improvement on depression symptoms. For Hispanics, satisfaction with life did not significantly improve in the OPT only group, in contrast to whites and African Americans who improved over time on all measures. Attitudes toward medications did not differ across ethnic/racial groups.
  
  
  CONCLUSIONS
  African Americans show some greater improvements with lithium than non-Hispanic whites, and Hispanics showed more consistent improvements in the lithium group. The impact of low-dose lithium should be studied in a larger sample as there may be particular benefit for African Americans and Hispanics. Given that the control group (regardless of ethnicity/race) had significant improvements, optimized treatment may be beneficial for any ethnic group.
authors.affiliation: University of Texas Health Science Center San Antonio, USA. Electronic address: arnoldjg@uthscsa.edu.
authors.forename: Jodi
authors.initials: J
authors.lastname: Gonzalez Arnold
authors.affiliation: Massachusetts General Hospital - Bipolar Clinic and Research Program, USA.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Salcedo
authors.affiliation: Stanford University School of Medicine, USA.
authors.forename: Terrence A
authors.initials: TA
authors.lastname: Ketter
authors.affiliation: Case Western Reserve University, USA.
authors.forename: Joseph R
authors.initials: JR
authors.lastname: Calabrese
authors.affiliation: Massachusetts General Hospital - Bipolar Clinic and Research Program, USA.
authors.forename: Dustin J
authors.initials: DJ
authors.lastname: Rabideau
authors.affiliation: Massachusetts General Hospital - Bipolar Clinic and Research Program, USA.
authors.forename: Andrew A
authors.initials: AA
authors.lastname: Nierenberg
authors.affiliation: University of Texas Health Science Center San Antonio, USA.
authors.forename: Melissa
authors.initials: M
authors.lastname: Bazan
authors.affiliation: Massachusetts General Hospital - Bipolar Clinic and Research Program, USA.
authors.forename: Andrew C
authors.initials: AC
authors.lastname: Leon
authors.affiliation: University of Pittsburgh School of Medicine, USA.
authors.forename: Edward S
authors.initials: ES
authors.lastname: Friedman
authors.affiliation: Mount Sinai School of Medicine, USA.
authors.forename: Dan
authors.initials: D
authors.lastname: Iosifescu
authors.affiliation: Massachusetts General Hospital - Bipolar Clinic and Research Program, USA.
authors.forename: Louisa G
authors.initials: LG
authors.lastname: Sylvia
authors.affiliation: Stanford University School of Medicine, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Ostacher
authors.affiliation: University of Pennsylvania School of Medicine, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Thase
authors.affiliation: Massachusetts General Hospital - Bipolar Clinic and Research Program, USA.
authors.forename: Noreen A
authors.initials: NA
authors.lastname: Reilly-Harrington
authors.affiliation: University of Texas Health Science Center San Antonio, USA.
authors.forename: Charles L
authors.initials: CL
authors.lastname: Bowden
mesh_terms: D000328:Adult; D001741:Black or African American / Q000523:psychology* / Q000706:statistics & numerical data*; D018692:Antimanic Agents / Q000008:administration & dosage*; D001290:Attitude; D001714:Bipolar Disorder / Q000188:drug therapy*; D004334:Drug Administration Schedule; D005260:Female; D006630:Hispanic or Latino / Q000523:psychology* / Q000706:statistics & numerical data*; D006801:Humans; D053208:Kaplan-Meier Estimate; D018020:Lithium Compounds / Q000008:administration & dosage*; D008297:Male; D011446:Prospective Studies; D044465:White People / Q000706:statistics & numerical data
chemical_list: D018692:Antimanic Agents; D018020:Lithium Compounds
keywords: African Americans; Bipolar disorder; Health disparities; Hispanics; Lithium; Treatment outcome
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