LITHIUM COMPARED TO VALPROIC ACID AND CARBAMAZEPINE IN THE TREATMENT OF MANIA - A STATISTICAL METAANALYSIS

The hypothesis that lithium is the most appropriate and efficacious ph armacological treatment in the therapy of manic-depressive illness was examined in a meta-analysis. The efficacy of lithium was compared wit h that of the antiepileptics, carbamazepine and valproic acid. Data so urces include the Medline database and relevant references from articl es. Only randomised controlled clinical trials with a double-blind ass essment of outcomes were included. Lithium levels were required to be within the therapeutic range of 0.4-1.5 mmol/l. The effect sizes were measured by the odds ratio using the Mantel-Haenszel method. No signif icant difference was observed between the treatment effect of the 3 dr ugs compared. While the efficacy of the 3 treatments was identical, th ere is a general tendency in favour of the antiepileptics in the treat ment of manic depression with regard to adverse events and treatment t olerance. The impact and importance of this study seriously question t he relevance of today's practice of prescribing lithium in the acute m anagement of manic-depressive illness.