6 March 2017

World-first study shows 70s mood stabiliser lithium outperforms its modern equivalent

World-first study shows 70s mood stabiliser lithium outperforms its modern equivalent

Orygen, The National Centre of Excellence in Youth Mental Health in partnership with Deakin University have released the results of a world-first study testing the effects of lithium, a mood stabiliser introduced in the 1970s, and comparing it with those of quetiapine, a more modern and commonly prescribed alternative.

Published in the British Journal of Psychiatry the study looked at 61 people with first episode mania, half of whom were given lithium and the other half quetiapine to manage their symptoms.  In the year after their first episode of mania the results showed the older medication lithium to be superior to quetiapine in terms of symptoms of mania, psychosis, depression, quality of life and functioning. 

‘These are surprising findings for a number of reasons. The previous literature suggests that these medicines are broadly equivalent, but this is the first study to look at a first episode population where there is reason to believe that medicines like lithium might do better if used earlier in the illness course,’ said lead researcher Professor Michael Berk, Director of Deakin University’s Centre for Innovation in Mental and Physical and Clinical Treatment.

Mood stabilisers such as lithium and quetiapine are the mainstay of treatment for the symptoms of bipolar disorder, but until now, little was known about which treatments were more effective in people who had experienced a recent first episode of mania, defined as the beginning of bipolar disorder.

Developed over 40 years ago, marketing and other forces have seen lithium gradually fall out of favour as a treatment for the disorder. This is despite the fact that most guidelines recommend it as a first-line treatment. Consequently, newer treatments such as quetiapine have gained traction and taken over lithium as a more commonly prescribed alternative.

‘The results of this study suggest that lithium probably should retain its position as a first-line choice for treatment of this disorder generally, and particularly in people at the earliest stages of their illness,’ said Professor Berk.

The study found that although lithium remains the most effective agent for treating first episode mania it also becomes less effective for those who have experienced multiple episodes. Therefore the results further support both the idea of early invention and the importance of having specialist first episode treatment facilities for young people to access, such as headspace and the Early Psychosis Prevention and Intervention Centres (EPPIC).

‘The first episode is a unique opportunity because both psychological and pharmacological treatments seem most effective at that point. Failure to offer the best treatments at the earliest opportunity is associated with a lower likelihood that the person is going to respond to treatment and have an optimal outcome. This research therefore supports the importance of early intervention,’ Professor Berk said.