Results of a randomized controlled trial showed a clear benefit of lithium over quetiapine monotherapy in stabilizing patients following a first episode of bipolar mania. Lithium was superior across several measures of disease severity, symptomatology, and quality of life during the 12 months following the transition to maintenance therapy. These findings were reported in the British Journal of Psychiatry.
Investigators from multiple institutions in Australia and New Zealand screened 286 individuals with a first manic episode with psychotic features from the National Centre of Excellence in Youth Mental Health, the Early in Life Mental Health Service (ELMHS), and the Recovery and Prevention of Psychosis (RAPP) services at Monash Health in Melbourne, Australia, ultimately enrolling 61 patients age 17 to 26 who were treated initially with a combination of quetiapine and lithium. After the patients were randomly assigned to receive either drug as monotherapy, 40 patients completed the trial (19 taking quetiapine, 21 taking lithium).
Overall, lithium consistently showed better recovery across multiple features of depression, mania, and psychotic symptoms on the Bipolar Depression Rating Scale (BDRS), Montgomery-Asberg Depression Rating Scale (MADRS), and the Young Mania Rating Scale (YMRS), as well as clinical measures of functional outcomes.
Using global measures on the Brief Psychiatric Rating Scale (BPRS), patients in the quetiapine group worsened significantly from baseline to 12 months, while patients in the lithium group improved over the same time period. The quetiapine group also experienced a significant worsening of manic symptoms at 9 months measured by the Clinical Global Impressions Scale for Bipolar Disorder (CGI-BP) compared with lithium.