Research reportLithium versus carbamazepine in the maintenance treatment of bipolar disorders – a randomised study
Section snippets
General study design
The MAP study group consisted of nine psychiatric university hospitals in the Federal Republic of Germany (Aachen, Berlin, Düsseldorf, Heidelberg, Lübeck, Munich, Münster, Tübingen, Würzburg). Approval of local ethical committees was obtained according to legal requirements.
At the beginning of the study, all patients with affective syndromes admitted to one of the hospitals were screened (recruitment phase). Patients fulfilling the inclusion criteria were followed in the out-patient department
Study patients and non-completers
Table 1 shows sociodemographic and clinical characteristics of the 144 patients. 74 (51%) patients were randomised to lithium, 70 (49%) to carbamazepine. No significant differences regarding age, sex, number of previous episodes, attempted suicides, severity of symptomatology and other characteristics were observed between the treatment groups. Using the Structured Clinical Interview for DSM-III-R (SCID; Wittchen et al., 1987), 91% of the ICD-9 diagnosed patients fulfilled the DSM-III-R
Discussion
In the present study on maintenance treatment of bipolar disorder, the efficacy of lithium was comparable to that of carbamazepine as far as hospitalisations and recurrences are concerned. However, for the latter a trend in favour of lithium was observed. If treatment failure was defined as “recurrence and/or the necessity of antidepressant or neuroleptic comedication for a period of at least 6 months”, lithium was significantly superior to carbamazepine. Following Montgomery and Dunbar (1993),
Conclusion
The results indicate that in maintenance treatment of bipolar disorder lithium and carbamazepine might be equipotent when using hospitalisation or recurrence as outcome criteria. Considering, however, need of concomitant psychotropic medication and occurrence of severe side effects as additional failure criteria, lithium demonstrates a clear superiority. On the other hand, concerning long-term tolerability, carbamazepine seems to cause fewer slight and moderate side effects as reported by the
Acknowledgements
The authors gratefully thank all participating patients and the psychiatrists who were involved in recruitment and data collection in the individual centres. For supporting manuscript preparation we thank B. Henkel and U. Hegerl.
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