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. 2016 Feb;15(1):53-8.
doi: 10.1002/wps.20298.

Lithium vs. valproate vs. olanzapine vs. quetiapine as maintenance monotherapy for bipolar disorder: a population-based UK cohort study using electronic health records

Joseph F Hayes  1 , Louise Marston  2 , Kate Walters  2 , John R Geddes  3 , Michael King  1 , David P J Osborn  1
Affiliations

Lithium vs. valproate vs. olanzapine vs. quetiapine as maintenance monotherapy for bipolar disorder: a population-based UK cohort study using electronic health records

Joseph F Hayes et al. World Psychiatry. 2016 Feb.

Abstract

It is unclear which maintenance treatment for bipolar disorder is superior in clinical practice. Randomized controlled head-to-head trials of available drugs either do not exist or are inconclusive. We aimed to compare rates of monotherapy treatment failure in individuals prescribed lithium, valproate, olanzapine or quetiapine by a population-based cohort study using electronic health records. 5,089 patients with bipolar disorder were prescribed lithium (N=1,505), valproate (N=1,173) olanzapine (N=1,366) or quetiapine (N=1,075) as monotherapy. Treatment failure was defined as time to stopping medication or add-on of another mood stabilizer, antipsychotic, antidepressant or benzodiazepine. In unadjusted analyses, the duration of successful monotherapy was longest in individuals treated with lithium. Treatment failure had occurred in 75% of those prescribed lithium by 2.05 years (95% CI: 1.63-2.51), compared to 0.76 years (95% CI: 0.64-0.84) for those prescribed quetiapine, 0.98 years (95% CI: 0.84-1.18) for those prescribed valproate, and 1.13 years for those prescribed olanzapine (95% CI: 1.00-1.31). Lithium's superiority remained in a propensity score matched analysis; when treatment failure was defined as stopping medication or add-on of a mood stabilizer or antipsychotic; and when treatment failure was restricted to more than three months after commencing the study drug. Lithium appears to be more successful as monotherapy maintenance treatment than valproate, olanzapine or quetiapine. Lithium is often avoided because of its side effect profile, but alternative treatments may reduce the time to being prescribed more than one drug, with potential additive side effects of these treatments.

Keywords: Bipolar disorder; cohort study; electronic health records; lithium; maintenance treatment; olanzapine; quetiapine; valproate.

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Figures

Figure 1
Figure 1
Time to treatment failure (stopped treatment or add‐on of mood stabilizer, antipsychotic, antidepressant or benzodiazepine) (unadjusted)
Figure 2
Figure 2
Time to treatment failure (excluding failures in the first three months of treatment) (unadjusted)
See this image and copyright information in PMC

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References

    1. Saunders KE, Goodwin GM. The course of bipolar disorder. Adv Psychiatr Treat 2010;16:318‐28.
    1. Murray CJ, Lopez AD. Global mortality, disability, and the contribution of risk factors: Global Burden of Disease Study. Lancet 1997;349:1436‐42. - PubMed
    1. Perlis RH, Ostacher MJ, Patel JK et al. Predictors of recurrence in bipolar disorder: primary outcomes from the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP‐BD). Am J Psychiatry 2006;163:217‐24. - PubMed
    1. Hayes J, Prah P, Nazareth I et al. Prescribing trends in bipolar disorder: cohort study in the United Kingdom THIN primary care database 1995‐2009. PLoS One 2011;6:e28725. - PMC - PubMed
    1. National Institute for Health and Care Excellence . Bipolar disorder: the management of bipolar disorder in adults, children and adolescents, in primary and secondary care. GC38. London: National Institute for Health and Care Excellence, 2006.