Institute of Pharmacology, Hannover Medical School, Carl-Neuberg-Straße 1, D-30625, Hannover, Germany.
Naunyn Schmiedebergs Arch Pharmacol. 2024 Dec;397(12):9723-9743. doi: 10.1007/s00210-024-03210-8. Epub 2024 Jun 25.
Lithium is the gold standard drug in the treatment of bipolar disorder. Despite increasing scientific interest, relatively few patients with bipolar disorder receive lithium therapy. Lithium is the only drug that is effective in the prophylaxis of manic, depressive, and suicidal symptoms. Lithium therapy is also associated with a variety of adverse drug reactions and the need for therapeutic drug monitoring. Numerous studies have focussed on the efficacy and safety of both lithium-monotherapy and lithium-add-on therapy. The aim of this study is to provide a systematic overview of clinical studies on lithium therapy for bipolar disorder from the last 7 years and to present a critical analysis of these studies. The results provide an up-to-date overview of the efficacy, tolerability, and safety of lithium therapy for bipolar disorder and thus improve the pharmacotherapy of bipolar disorder. A total of 59 studies were analysed using various analysis parameters. The studies were also categorised into different subgroups. These are lithium-monotherapy, lithium vs. placebo/drug, and lithium + adjunctive therapy. The majority of the studies (N = 20) had a duration of only 3-8 weeks. Only 13 studies lasted for > 40 weeks. Lithium was superior to aripiprazole, valproic acid, and quetiapine in terms of improving manic symptoms. Lithium therapy resulted in a lower relapse rate compared to valproic acid therapy. Lithium was more neuroprotectively effective than quetiapine. Fourteen of the 22 add-on therapies to lithium showed a predominantly positive effect on the treatment outcome compared to lithium-monotherapy. Only the add-on therapy with sertraline led to a higher rate of study discontinuations than lithium-monotherapy. Lithium is a safe and effective treatment option for children. However, risperidone and quetiapine were superior to lithium in some aspects, which is why these drugs should be considered as an alternative treatment option for children. Collectively, current clinical studies highlight the relevance of lithium in the treatment of bipolar disorder.
锂盐是治疗双相障碍的金标准药物。尽管人们对它的科学研究兴趣日益增加，但接受锂盐治疗的双相障碍患者相对较少。锂盐是唯一能有效预防躁狂、抑郁和自杀症状的药物。锂盐治疗还与各种药物不良反应和治疗药物监测需求有关。许多研究都集中在锂盐单药治疗和锂盐附加治疗的疗效和安全性上。本研究旨在对过去 7 年中关于锂盐治疗双相障碍的临床研究进行系统综述，并对这些研究进行批判性分析。研究结果提供了关于锂盐治疗双相障碍的疗效、耐受性和安全性的最新概述，从而改善了双相障碍的药物治疗。使用各种分析参数对 59 项研究进行了分析。这些研究还分为不同的亚组，即锂盐单药治疗、锂盐与安慰剂/药物治疗和锂盐+附加治疗。大多数研究（N=20）的持续时间仅为 3-8 周，只有 13 项研究持续时间超过 40 周。与阿立哌唑、丙戊酸和喹硫平相比，锂盐在改善躁狂症状方面更具优势。与丙戊酸治疗相比，锂盐治疗导致复发率更低。与喹硫平相比，锂盐更具神经保护作用。与锂盐单药治疗相比，22 种附加治疗中有 14 种对治疗结果显示出主要的积极影响。只有锂盐附加治疗舍曲林导致的研究中止率高于锂盐单药治疗。锂盐是儿童安全有效的治疗选择。然而，利培酮和喹硫平在某些方面优于锂盐，因此这些药物应被视为儿童的替代治疗选择。总的来说，目前的临床研究强调了锂盐在双相障碍治疗中的重要性。
