Evid Based Mental Health 7:72 doi:10.1136/ebmh.7.3.72
  • Therapeutics

Review: lithium reduces relapse rates in people with bipolar disorder

 Q Does lithium reduce relapse rates in people with bipolar disorder?



Systematic review with meta-analysis.

GraphicData sources:

The Cochrane Collaboration databases, reference lists, textbooks, relevant journals, and conference abstracts were searched. Trial authors were contacted, as were other experts and pharmaceutical companies.

GraphicStudy selection and analysis:

Randomised controlled trials (RCTs) of ⩾3 months, comparing lithium with placebo for the maintenance of bipolar disorder were included. Trials where one group abruptly discontinued lithium and those with mixed groups of people with bipolar and unipolar disorder were excluded. Study quality was assessed to determine allocation concealment and blinding. STATA software was used to conduct meta-analyses, leading to pooled fixed effects and random effects relative risk (RR) ratios.


Risk of relapse (total, manic, depressive), total withdrawal rates, risk of specific adverse events.


Five RCTs met inclusion criteria (n = 770), with follow up periods of 11 months to four years. Total relapses: lithium prevented significantly more relapses compared with placebo (risk of relapse, lithium v placebo: 40% v 60%; RR 0.65, 95% CI …