Department of Psychiatry, Leiden University Medical Centre, Leiden, The Netherlands.
Psychiatric Institute, GGZ Rivierduinen, Outpatient Clinic for Mental Disability and Psychiatry, Leiden, The Netherlands.
Hum Psychopharmacol. 2023 Sep;38(5):e2881. doi: 10.1002/hup.2881. Epub 2023 Oct 3.
Lithium is widely used as treatment of acute mania and as prophylactic therapy for bipolar disorder. International and national guidelines also consider lithium as a possible treatment of acute bipolar depression. Research on the use of lithium in bipolar depression, however, seems to be limited compared to the data available for its efficacy in the other phases of bipolar disorder.
To provide a systematic review of the evidence for lithium in the treatment of acute bipolar depression and provide directions for further research.
A systematic review of clinical studies investigating the use of lithium in bipolar depression was performed using preferred reporting items for systematic reviews and meta-analyses guidelines in Pubmed, Embase and Psychinfo using the medical subjects headings and free text terms "lithium," "bipolar depression," "dosage," "serum concentration" and "bipolar disorders."
This review included 15 studies with a total of 1222 patients, between the age of 18 and 65, suffering from bipolar depression of which 464 were treated with lithium. There are currently only limited and low-quality data on the efficacy of lithium as a treatment of bipolar depression. It appears that there have been no placebo controlled randomized controlled trials with lithium concentrations that are considered to be therapeutic. The older studies suffered from limitations such as small sample sizes, insufficient treatment lengths, and insufficient monitoring of serum concentrations.
In contrast to data for the treatment of mania and prophylaxis, robust data on the efficacy of lithium in bipolar depression is currently lacking, making it impossible to make conclusions regarding efficacy or inefficacy, for which further research is needed.
锂被广泛用于治疗急性躁狂症和预防双相情感障碍。国际和国家指南也认为锂是急性双相抑郁症的一种可能治疗方法。然而，与锂在双相障碍其他阶段的疗效数据相比，锂在双相抑郁症中的应用研究似乎有限。
对锂治疗急性双相抑郁症的证据进行系统评价，并为进一步研究提供方向。
使用 Pubmed、Embase 和 Psychinfo 中的首选报告项目进行系统评价和荟萃分析指南，使用医学主题词和自由文本术语“锂”、“双相抑郁症”、“剂量”、“血清浓度”和“双相障碍”，对锂在双相抑郁症中的应用进行了临床研究的系统评价。
本综述包括 15 项研究，共 1222 名年龄在 18 至 65 岁之间的双相抑郁症患者，其中 464 名接受了锂治疗。目前，关于锂作为双相抑郁症治疗的疗效仅有有限的低质量数据。似乎没有使用被认为是治疗性的锂浓度的安慰剂对照随机对照试验。较旧的研究存在一些局限性，如样本量小、治疗时间不足、血清浓度监测不足等。
与治疗躁狂症和预防的疗效数据相比，目前缺乏锂治疗双相抑郁症的疗效的可靠数据，因此无法就其疗效或无效性得出结论，需要进一步研究。
