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Lithium versus antidepressants in the long-term treatment of unipolar affective disorder

  • Review
  • Intervention

Authors


Abstract

Background

The main rationale for the use of lithium in the long-term treatment of unipolar affective disorder is its efficacy in treating bipolar affective disorder and resistant depression. However, there is considerable uncertainty about which pharmacological intervention is most effective in the long-term treatment of recurrent unipolar affective disorder.

Objectives

To assess the effects of lithium versus antidepressants for the long-term treatment of recurrent affective disorder.

Search methods

We searched the Cochrane Collaboration Depression, Anxiety and Neurosis Controlled Trials Registers (CCDANCTR-Studies and CCDANCTR-References) on 2/9/2005. Reference lists of relevant papers and major textbooks of affective disorder were checked. Experts in the field and pharmaceutical companies were contacted regarding unpublished material.

Selection criteria

Randomised controlled trials comparing lithium against antidepressant medication for the long-term treatment of patients with a diagnosis of affective disorder.

Data collection and analysis

Two authors independently assessed trial quality and extracted data. We contacted study authors for additional information. We collected adverse effects information from the trials.

Main results

Eight trials involving 475 people were included. Two of the studies included a mixed group of participants with either bipolar or unipolar disorder. Relapse was defined as admission to hospital and when all kinds of relapses were considered (both depressive and manic), there was a statistically significant difference in favour of lithium (relative risk (RR) fixed effect 0.34, 95% CI 0.14 to 0.82). The results did not exclude the point of no effect, when the random-effects model was used (RR random effects 0.40, 95% CI 0.14 to 1.18). There were no other statistically significant differences between lithium and antidepressants according to all other outcomes considered. Manic or depressive relapse was defined as prescription of non-study medication for mood disorder, manic or depressive relapse (as defined by the study authors), quality of life, social functioning, occupational functioning, overall drop-out rate, drop-out rate due to side-effects, troublesome side-effects, mortality due to all causes and specifically suicides.

Authors' conclusions

There was adequate efficacy evidence for lithium or antidepressants preventing relapse in unipolar affective disorder, however their relative efficacy was unknown. When considering lithium or antidepressant long-term therapy, patients and clinicians should take into account the patient's clinical history, the side-effects and the individual's likely adherence to the recommended treatment regime. Large-scale, long-term randomised trials in unselected groups of subjects with unipolar affective disorder are needed.

摘要

背景

比較鋰鹽與與抗憂鬱劑長期治療單相情感疾患的效果(unipolar affective disorder)

以鋰鹽來長期治療單相情感疾患的主要邏輯是其在雙相情感疾患及難治型憂鬱上的治療效果。然而,仍不確定哪一種藥物介入處置才是長期治療復發的單相情感疾患中最有療效。

目標

比較鋰鹽與抗憂鬱劑在復發的情感疾患(affective disorder)長期治療的效果。

搜尋策略

我們在2005年2月9日搜尋the Cochrane Collaboration Depression, Anxiety and Neurosis Controlled Trials Registers (CCDANCTRStudies and CCDANCTRReferences)。相關文獻裡的參考文獻及情感疾患的重要教科書都被檢閱。對於未發表的資料,我們曾連絡這領域中的專家及製藥公司。

選擇標準

比較鋰鹽與抗憂鬱劑長期使用於情感疾患的隨機控制試驗。

資料收集與分析

兩位作者獨立評估試驗的品質及抽出的資料。我們連絡研究作者以取得額外的資料。我們收集試驗中的副作用資料。

主要結論

共有8個試驗,包括475個個案被納入。其中兩個研究收入混合型雙相或單相情感疾患的受試者。復發(relapse)定義為住院;而且當所有的復發被考慮時(憂鬱及躁症均是),鋰鹽在統計上有明顯優勢(相對風險 的固定效益為0.34, 95% CI為0.14 to 0.82)。當使用隨機療效模式(randomeffects model),結果不排除無效點(相對風險 (random effects)為0.40, 95% CI為0.14 to 1.18)。考量其他的結果,鋰鹽與抗憂鬱劑沒有其他統計上的顯著差別。躁症及憂鬱症復發被定義為為情感疾患、躁症、憂鬱症而開立非研究使用的藥物(由研究的作者定義)、生活品質、社交功能、職業功能、全部退出率、因副作用造成的退出率、困擾的副作用、因任何原因或自殺造成的死亡。

作者結論

有適當的證據支持鋰鹽及抗憂鬱劑可預防單相情感疾患的復發,然而他們相對的療效不清楚。當考慮長期使用鋰鹽及抗憂鬱劑,患者及臨床醫師須考量病史、副作用及個人對建議藥物的可能配合度。大型、長期、隨機針對單相情感疾患病人的試驗是需要的。

翻譯人

本摘要由彰化基督教醫院李柏賢翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

這篇系統性回顧調查比較鋰鹽與抗憂鬱劑在長期治療單相情感疾患的療效及耐受度。八個隨機試驗(報告475個受試者)包括在此回顧中。我們發現沒有可信賴的證據支持鋰鹽與抗憂鬱劑有明顯的差異,但我們可能無法排除臨床上明顯差異的可能性。在這篇回顧中,一些研究同時包括單相及雙相情感疾患的病人。這篇回顧建議,當鋰鹽可能在預防單相情感疾患的復發有助益時,與抗憂鬱劑的比較仍存在未定數。對回顧的詮釋應該考慮受試者的人數太小,且含括的研究有方法上的缺陷。

Plain language summary

Lithium versus antidepressants in the long-term treatment of unipolar affective disorder

This systematic review investigated the efficacy and tolerability of lithium compared to antidepressants for the long-term treatment of unipolar affective disorder. Eight randomised studies (reporting on 475 participants) were included in the review. We found no reliable evidence of any robust differences between lithium and antidepressants but nor could we reliably exclude the possibility of clinically significant differences. In this review some studies included a mixed group of participants with either bipolar or unipolar disorder. The review suggests that, while lithium may be of benefit in preventing relapse in unipolar affective disorder, there remains uncertainty about the treatment effect in comparison with antidepressants. Interpretation of this review should consider that the number of participants in the studies was small and the included studies had methodological shortcomings.

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