Quetiapine v. lithium in the maintenance phase following a first episode of mania: randomised controlled trial

Br J Psychiatry. 2017 Jun;210(6):413-421. doi: 10.1192/bjp.bp.116.186833. Epub 2017 Mar 2.

Abstract

BackgroundLithium and quetiapine are considered standard maintenance agents for bipolar disorder yet it is unclear how their efficacy compares with each other.AimsTo investigate the differential effect of lithium and quetiapine on symptoms of depression, mania, general functioning, global illness severity and quality of life in patients with recently stabilised first-episode mania.MethodMaintenance trial of patients with first-episode mania stabilised on a combination of lithium and quetiapine, subsequently randomised to lithium or quetiapine monotherapy (up to 800 mg/day) and followed up for 1 year. (Trial registration: Australian and New Zealand Clinical Trials Registry - ACTRN12607000639426.)ResultsIn total, 61 individuals were randomised. Within mixed-model repeated measures analyses, significant omnibus treatment × visit interactions were observed for measures of overall psychopathology, psychotic symptoms and functioning. Planned and post hoc comparisons further demonstrated the superiority of lithium treatment over quetiapine.ConclusionsIn people with first-episode mania treated with a combination of lithium and quetiapine, continuation treatment with lithium rather than quetiapine is superior in terms of mean levels of symptoms during a 1-year evolution.

Publication types

  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Antimanic Agents / therapeutic use
  • Antipsychotic Agents / therapeutic use
  • Bipolar Disorder / diagnosis
  • Bipolar Disorder / drug therapy*
  • Drug Therapy, Combination
  • Female
  • Humans
  • Lithium Compounds / therapeutic use*
  • Male
  • Quality of Life
  • Quetiapine Fumarate / therapeutic use*
  • Single-Blind Method
  • Treatment Outcome
  • Young Adult

Substances

  • Antimanic Agents
  • Antipsychotic Agents
  • Lithium Compounds
  • Quetiapine Fumarate

Associated data

  • ANZCTR/ACTRN12607000639426