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The effectiveness of restarted lithium treatment after discontinuation: reviewing the evidence for discontinuation‐induced refractoriness
Author(s) -
Vries Christine,
Bergen Annet,
Regeer Eline J,
Benthem Elsje,
Kupka Ralph W,
Boks Marco PM
Publication year - 2013
Publication title -
bipolar disorders
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.285
H-Index - 129
eISSN - 1399-5618
pISSN - 1398-5647
DOI - 10.1111/bdi.12105
Subject(s) - discontinuation , lithium (medication) , meta analysis , medicine , confidence interval , odds ratio , cochrane library , pediatrics
Objectives We sought to determine whether the risk of relapse in patients with bipolar disorder is higher after discontinuation and restart of lithium treatment as compared to continuous lithium treatment in these same patients. Methods We conducted literature searches in the Pubmed, Embase, Cochrane, and Psyc INFO databases with cross‐reference checks. Relevant data were extracted and pooled for meta‐analysis. Results Five relevant studies were included for review, of which three studies qualified for the meta‐analysis and included a total of 212 analyzed cases. Two studies found lithium to be less effective after discontinuation and reintroduction and three studies found no decreased effectiveness. The pooled odds ratio for the occurrence of one or more relapses after interruption of lithium treatment compared to continuous treatment was 1.40 (95% confidence interval: 0.85–2.31; p = 0.19). Conclusions Although studies are scarce, review and meta‐analysis of the available literature does not provide convincing evidence that lithium is less effective when treatment is discontinued and restarted, compared to uninterrupted treatment.