Lithium versus antidepressants in the long‐term treatment of unipolar affective disorder

Andrea Cipriani; Katharine A Smith; Sally SA Burgess; Stuart M Carney; Guy Goodwin; John Geddes

doi:10.1002/14651858.CD003492.pub2

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Analysis 1.1

Comparison 1 Lithium vs antidepressants, Outcome 1 All relapses.

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Analysis 1.2

Comparison 1 Lithium vs antidepressants, Outcome 2 Depressive relapse.

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Analysis 1.3

Comparison 1 Lithium vs antidepressants, Outcome 3 Manic relapse.

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Analysis 1.4

Comparison 1 Lithium vs antidepressants, Outcome 4 Overall dropout rate.

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Analysis 1.5

Comparison 1 Lithium vs antidepressants, Outcome 5 Dropout rate due to side effects.

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Analysis 1.6

Comparison 1 Lithium vs antidepressants, Outcome 6 Side effects.

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Analysis 1.7

Comparison 1 Lithium vs antidepressants, Outcome 7 Mortality.

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Analysis 1.8

Comparison 1 Lithium vs antidepressants, Outcome 8 Suicide.

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Comparison 1. Lithium vs antidepressants

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 All relapses Show forest plot	8		Risk Ratio (M‐H, Fixed, 95% CI)	Subtotals only

1.1 Admission to hospital	3	152	Risk Ratio (M‐H, Fixed, 95% CI)	0.34 [0.14, 0.82]
1.2 Non‐study medication	3	249	Risk Ratio (M‐H, Fixed, 95% CI)	0.81 [0.62, 1.05]
1.3 Relapse however defined	7	434	Risk Ratio (M‐H, Fixed, 95% CI)	1.00 [0.81, 1.24]
2 Depressive relapse Show forest plot	6		Risk Ratio (M‐H, Fixed, 95% CI)	Subtotals only

2.1 Admission to hospital	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
2.2 Non‐study medication	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
2.3 Relapse however defined	6	404	Risk Ratio (M‐H, Fixed, 95% CI)	1.13 [0.90, 1.42]
3 Manic relapse Show forest plot	6		Risk Ratio (M‐H, Fixed, 95% CI)	Subtotals only

3.1 Admission to hospital	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
3.2 Non‐study medication	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
3.3 Relapse however defined	6	404	Risk Ratio (M‐H, Fixed, 95% CI)	0.46 [0.17, 1.25]
4 Overall dropout rate Show forest plot	6	345	Risk Ratio (M‐H, Fixed, 95% CI)	0.67 [0.43, 1.06]

5 Dropout rate due to side effects Show forest plot	4	262	Risk Ratio (M‐H, Fixed, 95% CI)	1.04 [0.31, 3.52]

6 Side effects Show forest plot	2		Risk Ratio (M‐H, Fixed, 95% CI)	Subtotals only

6.1 Any reported	2	203	Risk Ratio (M‐H, Fixed, 95% CI)	0.97 [0.78, 1.22]
6.2 Troublesome	1	76	Risk Ratio (M‐H, Fixed, 95% CI)	0.53 [0.20, 1.40]
7 Mortality Show forest plot	3	272	Risk Ratio (M‐H, Fixed, 95% CI)	0.39 [0.06, 2.60]

8 Suicide Show forest plot	8	475	Risk Ratio (M‐H, Fixed, 95% CI)	0.31 [0.03, 2.92]

Comparison 1. Lithium vs antidepressants

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