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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 4 of 4. This is the beginning of the thread.
Posted by SLS on January 5, 2013, at 20:31:47
Am J Psychiatry. 2013 Jan 1;170(1):102-10. doi: 10.1176/appi.ajp.2012.12060751
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Lithium Treatment Moderate-Dose Use Study (LiTMUS) for Bipolar Disorder: A Randomized Comparative Effectiveness Trial of Optimized Personalized Treatment With and Without Lithium.Nierenberg AA, Friedman ES, Bowden CL, Sylvia LG, Thase ME, Ketter T, Ostacher MJ, Leon AC, Reilly-Harrington N, Iosifescu DV, Pencina M, Severe JB, Calabrese JR.
Abstract
OBJECTIVE Lithium salts, once the mainstay of therapy for bipolar disorder, have tolerability issues at a higher dosage that often limit adherence. The authors investigated the comparative effectiveness of more tolerable dosages of lithium as part of optimized personalized treatment (OPT). METHOD The authors randomly assigned 283 bipolar disorder outpatients to 6 months of open, flexible, moderate dosages of lithium plus OPT or to 6 months of OPT alone. The primary outcome measures were the Clinical Global Impression Scale for Bipolar Disorder-Severity (CGI-BP-S) and "necessary clinical adjustments" (medication adjustments per month). Secondary outcome measures included mood symptoms and functioning. The authors also assessed sustained remission (defined as a CGI-BP-S score ≤2 for 2 months) and treatment with second-generation antipsychotics. The authors hypothesized that lithium plus OPT would result in greater clinical improvement and fewer necessary clinical adjustments. RESULTS The authors observed no statistically significant advantage of lithium plus OPT on CGI-BP-S scores, necessary clinical adjustments, or proportion with sustained remission. Both groups had similar outcomes across secondary clinical and functional measures. Fewer patients in the lithium-plus-OPT group received second-generation antipsychotics compared with the OPT-only group (48.3% and 62.5%, respectively). CONCLUSIONS In this pragmatic comparative effectiveness study, a moderate but tolerated dosage of lithium plus OPT conferred no symptomatic advantage when compared with OPT alone, but the lithium-plus-OPT group had less exposure to second-generation antipsychotics. Only about one-quarter of patients in both groups achieved sustained remission of symptoms. These findings highlight the persistent and chronic nature of bipolar disorder as well as the magnitude of unmet needs in its treatment.
Posted by Beckett on January 5, 2013, at 22:30:46
In reply to Lower dosages of lithium not effective for bipolar, posted by SLS on January 5, 2013, at 20:31:47
Hi Scott,
I'm titrating up lithium this week and needed some more upbeat news, so I searched the archives and found what follows. There is no way of knowing, but would you guess that they used high doses in the following study to achieve their results?
Posted by SLS on November 30, 2009, at 7:45:08In reply to Re: Lithium Monotherapy for Depression, posted by SLS on November 28, 2009, at 14:48:43
> I think the bipolar I/II dichotomy is valid as each responds to a different set of treatments.
Some of the more current literature calls into question whether there is such a large difference in the way bipolar I and bipolar II respond to lithium. Perhaps there isn't as large a difference in the way the two subtypes respond to medication as was initially reported.
- Scott
----------------------------------------------------Lithium Maintenance Treatment of Depression and Mania in Bipolar I and Bipolar II Disorders
Leonardo Tondo, M.D., Ross J. Baldessarini, M.D., John Hennen, Ph.D., and Gianfranco Floris, M.D.OBJECTIVE: Effects of long-term lithium treatment for depressive and manic phases of type I and type II bipolar disorders were compared. METHOD: Clinical research records of 317 patients with DSM-IV-defined bipolar disorder (188 with type I and 129 with type II) were analyzed for frequency and duration of affective episodes and hospitalizations before (mean=8.38 years) versus during (mean=6.35 years) lithium maintenance treatment. Treatment effects were also assessed by survival analysis of interepisode intervals and by multivariate regression testing for factors associated with response to treatment. RESULTS: Bipolar I and bipolar II patients were ill before treatment a similar percentage of time, but the subtype distinction was supported descriptively. Lithium had superior benefits in type II patients, with significantly greater reduction of episodes per year and of the percentage of time ill. Reduction of depressive morbidity was similarly strong in both diagnostic types. During treatment, bipolar II patients had 5.9-fold longer interepisode intervals and were twice as likely as type I patients to have no new episodes. Starting lithium maintenance earlier predicted greater improvement. CONCLUSIONS: Lithium maintenance yielded striking long-term reductions of depressive as well as manic morbidity in both bipolar disorder subtypes, with greater overall benefits in type II patients and with earlier treatment
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Posted by SLS on January 5, 2013, at 23:15:29
In reply to Re: Lower dosages of lithium not effective for bipolar » SLS, posted by Beckett on January 5, 2013, at 22:30:46
> Hi Scott,
Hi. I've been wondering about you. You are not easy to forget. You are good people who deserves better than to suffer. I hope the lithium works for you.
Are you taking Saphris?
> I'm titrating up lithium this week and needed some more upbeat news, so I searched the archives and found what follows. There is no way of knowing, but would you guess that they used high doses in the following study to achieve their results?I think they probably used a dosage of lithium that was accepted as being therapeutic at the time.
Blood level: 0.8 - 1.2 mEq/L (ng/dl).
Average dosage range: 900 - 1500 mg/day.
Some people are now using 0.6 mEq/L as the low end of therapeutic.
> Posted by SLS on November 30, 2009, at 7:45:08
>
> In reply to Re: Lithium Monotherapy for Depression, posted by SLS on November 28, 2009, at 14:48:43
>
> > I think the bipolar I/II dichotomy is valid as each responds to a different set of treatments.
>
> Some of the more current literature calls into question whether there is such a large difference in the way bipolar I and bipolar II respond to lithium. Perhaps there isn't as large a difference in the way the two subtypes respond to medication as was initially reported.
>
>
> - Scott
>
>
> ----------------------------------------------------
>
> Lithium Maintenance Treatment of Depression and Mania in Bipolar I and Bipolar II Disorders
> Leonardo Tondo, M.D., Ross J. Baldessarini, M.D., John Hennen, Ph.D., and Gianfranco Floris, M.D.
>
> OBJECTIVE: Effects of long-term lithium treatment for depressive and manic phases of type I and type II bipolar disorders were compared. METHOD: Clinical research records of 317 patients with DSM-IV-defined bipolar disorder (188 with type I and 129 with type II) were analyzed for frequency and duration of affective episodes and hospitalizations before (mean=8.38 years) versus during (mean=6.35 years) lithium maintenance treatment. Treatment effects were also assessed by survival analysis of interepisode intervals and by multivariate regression testing for factors associated with response to treatment. RESULTS: Bipolar I and bipolar II patients were ill before treatment a similar percentage of time, but the subtype distinction was supported descriptively. Lithium had superior benefits in type II patients, with significantly greater reduction of episodes per year and of the percentage of time ill. Reduction of depressive morbidity was similarly strong in both diagnostic types. During treatment, bipolar II patients had 5.9-fold longer interepisode intervals and were twice as likely as type I patients to have no new episodes. Starting lithium maintenance earlier predicted greater improvement. CONCLUSIONS: Lithium maintenance yielded striking long-term reductions of depressive as well as manic morbidity in both bipolar disorder subtypes, with greater overall benefits in type II patients and with earlier treatment
>
>
> -------------------------------------------
>
Posted by Beckett on January 6, 2013, at 10:37:32
In reply to Re: Lower dosages of lithium not effective for bipolar » Beckett, posted by SLS on January 5, 2013, at 23:15:29
Hi Scott,
One thing I did like about the study you originally posted was that a margin of people were able to do stay away from AAP's. Saphris did not work for me for many reasons, among them was it precipitated cycling and caused serious health side effects. Though I did sleep like a great brown bear on it.
I hear you are doing well. I hope that continues.
This is the end of the thread.
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