University of Pittsburgh, Pennsylvania.
University of Rochester Medical Center, New York.
J Am Acad Child Adolesc Psychiatry. 2020 Oct;59(10):1146-1155. doi: 10.1016/j.jaac.2019.06.013. Epub 2019 Jul 29.
Lithium is the mainstay for bipolar disorder (BD) treatment in adults, but evidence in youths is limited. We used data from the Course and Outcome of Bipolar Youth (COBY) study to assess whether lithium vs other mood-stabilizing medication (OMS) was associated with improved outcomes, including mood symptoms and suicidality.
COBY is a naturalistic, longitudinal study of 413 youths, 7 to 17.11 years old at intake, with BD. At each visit, medication exposure, psychiatric symptoms, and psychosocial function over the preceding follow-up period were assessed using the Adolescent Longitudinal Interval Follow-Up Evaluation. Using mixed models, we determined whether participants taking lithium vs OMS (but not lithium) differed regarding mood symptoms, suicidality, psychosocial function, hospitalization, aggression, and substance use.
A total of 340 participants contributed 2,638 six-month follow-up periods (886 lithium, 1,752 OMS), over a mean follow-up of 10 years. During lithium (vs OMS) follow-up periods, participants were older, less likely to have lifetime anxiety, and less likely to be on antidepressants (p values<.005). After covariate adjustment, the lithium group (vs OMS) had half as many suicide attempts (p = .03), fewer depressive symptoms (p = .004), less psychosocial impairment (p = .003), and less aggression (p = .0004). Similar findings were observed in the subgroup of follow-up periods in which participants were <18 years old.
Findings are consistent with adult studies, showing that lithium is associated with decreased suicidality, less depression, and better psychosocial functioning. Given the paucity of evidence regarding lithium in children and adolescents, these findings have important clinical implications for the pharmacological management of youths with BD.
在成人双相情感障碍（BD）的治疗中，锂是主要药物，但在青少年中的证据有限。我们使用 Course and Outcome of Bipolar Youth（COBY）研究的数据来评估锂与其他心境稳定剂（OMS）相比是否与改善结局相关，包括心境症状和自杀意念。
COBY 是一项自然主义、纵向研究，纳入了 413 名年龄在 7 至 17.11 岁的 BD 青少年。在每次就诊时，使用青少年纵向间隔随访评估（Adolescent Longitudinal Interval Follow-Up Evaluation）评估药物暴露、精神症状和过去随访期间的心理社会功能。使用混合模型，我们确定了锂与 OMS（而非锂）治疗的参与者在心境症状、自杀意念、心理社会功能、住院、攻击行为和物质使用方面是否存在差异。
共有 340 名参与者提供了 2638 个 6 个月随访期（886 例锂治疗，1752 例 OMS 治疗），平均随访时间为 10 年。在锂（与 OMS 相比）随访期间，参与者年龄更大，终生焦虑的可能性更小，服用抗抑郁药的可能性更小（p 值均<.005）。在调整了协变量后，锂组（与 OMS 相比）自杀企图的次数减少了一半（p =.03），抑郁症状减少了（p =.004），心理社会功能受损程度降低了（p =.003），攻击行为减少了（p =.0004）。在参与者年龄<18 岁的随访期亚组中也观察到了类似的结果。
这些发现与成人研究一致，表明锂与自杀意念减少、抑郁减轻和更好的心理社会功能相关。鉴于锂在儿童和青少年中的证据有限，这些发现对 BD 青少年的药物治疗具有重要的临床意义。
