Premium
Mood stabilizers in the prevention of recurrent affective disorders: a meta‐analysis
Author(s) -
Davis J. M.,
Janicak P. G.,
Hogan D. M.
Publication year - 1999
Publication title -
acta psychiatrica scandinavica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.849
H-Index - 146
eISSN - 1600-0447
pISSN - 0001-690X
DOI - 10.1111/j.1600-0447.1999.tb10890.x
Subject(s) - lithium (medication) , meta analysis , mood , mood stabilizer , placebo , carbamazepine , bipolar disorder , randomized controlled trial , psychology , mood disorders , psychiatry , relapse prevention , lithium therapy , medicine , clinical psychology , anxiety , epilepsy , pathology , alternative medicine
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. Method 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). Conclusion 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.