Lithium Add-ons Prove to Be No Help in Bipolar Disorder

The recent results of the LiTMUS trial produced few benefits in the addition of lithium to guideline-directed mood stabilizer therapy for bipolar disorder.

The recent results of the closely watched LiTMUS (Lithium Treatment Moderate Dose Use Study) trial produced few benefits in the addition of lithium carbonate to guideline-directed mood stabilizer therapy for bipolar disorder. The lithium carbonate instead increased the harmful effects in a major trial.

Dr. Joseph R. Calabrese, of Case Western Reserve University in Cleveland, stated that there was no different in the two primary endpoints among patients receiving lithium along with optimized mood stabilizer therapy compared to mood stabilizers alone. Calabrese also stressed that while adverse effects were more frequent early in the 24-week, 283-patient trial did not rule out a possible benefit for lithium in patients more able to tolerate the drug.

One-third of patients in the study required dosage adjustments due to adverse effects to lithium treatment. Results of an apparent responder analysis were still pending but may show that lithium was significantly positive in the other two-thirds of patients.

The LiTMUS trial gave the power to the individual treating clinicians to determine which mood stabilizers to prescribe with the only restriction stating that the agents had to be FDA-approved for bipolar disorder. Calabrese reported that adverse effects were significantly more common with add-on lithium when evaluated at week 4 and two weeks after that, the effects were not only more frequent but also more acute and immobilizing.

At week 6, 43.1% of patients in the lithium group reported mild, moderate, or severe side effects, compared with 31.3% of those receiving the optimized mood stabilizers alone. At week 24, most patients had received multiple dose adjustments and there were only slight trends toward more and worse side effects in the add-on lithium group.

In the past clinicians used lithium therapy most commonly to treat people with bipolar disorder, but it has lost favor in recent decades because of its negative effects and constant need for blood-level monitoring for dose titration.

Around the Web

APA: Add-On Lithium No Help in Bipolar Disorder [Medpage Today]

Lithium for Bipolar Disorder [WebMD]

Lithium Treatment for Bipolar Disorder [Everyday Health]