APA: Add-On Lithium No Help in Bipolar Disorder

[SashaSue]

This was interesting, and surprising.

http://www.medpagetoday.com/MeetingCoverage/APA/26544

[AirMarshall]

The way I read it, this is a NON-news story, because the researchers haven't finished crunching the numbers on patients who stayed on dual med treatment. It seems to me to be inappropriate to have released their incomplete results.

It is well known that there is a subset of bipolar patients who do not respond to lithium (regardless of side effects). I don't recall the percentage.

Of course something not a consideration of this study, is the expense consideration of treating patients with an AAP that costs over $100 a month vs. treating them with lithium at $25 a month, with comparable results.

Maybe younger psychiatrists need to be (re)trained to prescribe lithium more often and to better appreciate its benefits and risks.

[Guest]

Without reading the full study its hard to tell, But that artical also seems to suggest that 600mg was the ceiling dose used for lithium. If so its pretty much irrelivent.

[domovoi]

interesting, thanks for posting.

[Guest]

Without reading the full study its hard to tell, But that artical also seems to suggest that 600mg was the ceiling dose used for lithium. If so its pretty much irrelivent.

Yeah. This bothered me too. Also, they talked about not getting a level over 1.2, nothing about a minimum level.

As per http://clinicaltrials.gov/ct2/show/NCT00667745

Drug: Lithium Carbonate Lithium was started at 300 mg and then increased to 600 mg after 3 days. Lithium doses were maintained at 600 mg per day for 8 weeks, but may have been adjusted after that time as needed up to a serum level of 1.2 mEq/L.

600mg was the standard dose, It could be increased as needed. Not a high dose at all... But its still interesting.

[Guest]

600mg was the standard dose, It could be increased as needed. Not a high dose at all... But its still interesting.

600mg was the max dose during the first 8 weeks. Unless I'm reading this incorrectly. 600mg would give me a level of about 0.4. Not even close to theraputic. At a nontheraputic level for 8 weeks, I'd be batshit.

Thats how I read it too, And I would estimate a .3-4 level for me too at that dose.

[dedoubt]

If the study actually proves what the title states, then my new found semi-stability is just coincidental to my increase of lithium (and when the dose was decreased recently & I started going apeshit, then increased again w/better mood, that too was a coincidence). Yes, I have had multiple adjustments for dose & because of SEs, but I've had that with any number of meds. The quiet in my head is worth pretty much anything.

I can't take AAPs & my pdoc won't prescribe APs because he is pretty sure I will have similar reactions as to the AAPs. Tegretol didn't work, Lamictal didn't work, Depakote is meh so far after 6 months-- so just Topomax & Trileptal that I haven't tried. Which leaves me with lithium. And leaves me pissed that this kind of study is being published-- less than 300 patients in the trial and they are rushing to let the world know that "Lithium No Help in Bipolar Disorder." <--- *that* is all anyone will see, and that is all the AP is likely to pick up from this. A catchy headline based on a very small part of the story.

My 16 year old son just told me I have to go to bed. Apparently he doesn't have to because school is out. I'd better go before I get grounded.

[SashaSue]

Without reading the full study its hard to tell, But that artical also seems to suggest that 600mg was the ceiling dose used for lithium. If so its pretty much irrelivent.

Yeah. This bothered me too. Also, they talked about not getting a level over 1.2, nothing about a minimum level.

As I understood it, the dosage was increased as needed, for each individual patient.

[Cetkat]

with lithium or mood stabilizer therapy. Patients with substance use problems or other psychiatric illnesses, who would typically be barred from drug company-sponsored studies, were allowed into LiTMUS

LiTMUS protocol left it to individual treating clinicians to determine which mood stabilizers to prescribe. The only restriction was that the agents had to be FDA-approved for bipolar disorder. Patients in both treatment arms could receive one or more of these agents.

Not exactly the greatest controlled study. Way too many variables. STAR*D was about adding to treatment combos until a certain percentage of patients responded in order to show how multiple classes of meds could be used together successfully. At no point that I'm aware of does it state that those meds in particular should be used specifically. Yeah, Lithium is it's own class of med, but still.. IMO STAR*D was alot more limiting with the possible combinations that were being tested. I have also never come across a doc that used STAR*D's meds/order exactly as a treatment plan. (Although it's possible)

Note that adverse effects were more frequent early in the 24-week trial, and one-third of patients in the study required dosage adjustments because of adverse effects related to lithium treatment.

I read this to mean that there is a strong possibility that 1/3 of the patients were not medicated to within the therapeutic serum range because they couldn't tolerate it.

[AnneMarie]

It doesn't sound like there was much of a control for other meds, and if there was insufficient control, they can't make legit conclusions about just one med in the mix.

Lithium works for me regardless of this headline.

[Velvet Elvis]

It doesn't sound like there was much of a control for other meds, and if there was insufficient control, they can't make legit conclusions about just one med in the mix.

Lithium works for me regardless of this headline.

The whole point of the trial was testing its use as an adjunct. What I read it as saying is that if a person already has their bp controlled, there is no value in adding Li.

[AnneMarie]

It doesn't sound like there was much of a control for other meds, and if there was insufficient control, they can't make legit conclusions about just one med in the mix.

Lithium works for me regardless of this headline.

The whole point of the trial was testing its use as an adjunct. What I read it as saying is that if a person already has their bp controlled, there is no value in adding Li.

That would be a rather pointless study. If it's under control, how can more meds be measured since, you know, it was under control to begin? And, who would want more meds for something under control already.

If you give people in group A meds shown to be highly effective in treating bipolar... and you give people in group B meds that are total hit or miss but mostly miss meds for bipolar... and then you add on Lithium to group B saying subtherapeutic is fine, the results might not favor Lithium. By not controlling for who's on what, and not requiring a therapeutic serum level, the study scores not points with me.