New trial should clarify lithium use in bipolar disorder

doi:10.1136/bmj.325.7361.441

BMJ 2002;325:441 ( 24 August )

Letters

New trial should clarify lithium use in bipolar disorder

The first 150 words of the full text of this article appear below.

EDITOR $---$ We agree with Dinan's statement in his editorial that there is considerable evidence that lithium is an effective maintenancetreatment in bipolar disorder.¹ Our recent Cochrane reviewfound that lithium reduced the relative risk of relapse in bipolardisorder by 42% (95% confidence interval 30% to 52%).² We alsoaccept that the widespread switch away from lithium $---$ especiallyin the United States $---$ is based on marketing and opinion ratherthan compelling evidence. The absence of good evidence for valproatedoes not mean, of course, that lithium is more efficacious ormore acceptable than valproate. It is also possible that the combinationof lithium plus valproate is more effective than either drug alone.We are therefore less confident in accepting the unequivocal recommendationthat lithium should remain the first line treatment. There isgenuine clinical uncertainty about this issue $---$ and such wide internationalvariations in clinical practice $---$ that an . . . [Full text of this article]

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