Adrian Preda, MD
Does lithium increase risk for adverse events in patients with depression, bipolar disorder, or schizoaffective disorder?
Included studies assessed the association between lithium and ≥ 1 of the specified adverse events in patients with depression, bipolar disorder, or schizoaffective disorder. Outcomes included renal function (glomerular filtration rate [GFR] and urinary concentrating ability), thyroid function (thyroid-stimulating hormone), subclinical or clinical hypothyroidism, hyperthyroidism, parathyroid function (total calcium and parathyroid hormone [PTH]), weight change (> 7% change in total weight in kg), and skin disorders.
MEDLINE, EMBASE/Excerpta Medica, CINAHL, PsycINFO, Cochrane Library, Biosis Previews, and TOXNET database (all to 2010); Lithium, Lithium Therapy Monographs, and Teratology; reference lists; textbooks; and conference abstracts were searched for randomized controlled trials (RCTs), prospective cohort studies, case–control studies, uncontrolled prospective cohort studies, or case reports. Manufacturers of lithium, clinical experts, and authors were contacted. 22 RCTs; 197 case–control, uncontrolled cohort, or cross-sectional studies; and 166 case reports met inclusion criteria. The authors reported the results of the highest level of evidence for each outcome. Only results of meta-analyses of RCTs or case–control studies are reported in this abstract.
The main results are reported in the Table.
Meta-analysis of randomized controlled trials showed that lithium is associated with increased risk for weight gain compared with placebo. Meta-analyses of case–control studies showed that lithium increases risk for reduced urinary concentrating ability, hypothyroidism, and hyperparathyroidism but not glomerular filtration rate.
Adverse effects of lithium in patients with depression, bipolar disorder, or schizoaffective disorder*
*GFR = glomerular filtration rate; RCT = randomized controlled trial; TSH = thyroid-stimulating hormone; WMD = weighted mean difference; other abbreviations defined in Glossary.
†RRI, RRR, NNH, NNT, and CI calculated from control event rates and odds ratios in article using a random-effects model.
‡Data provided by authors.
Preda A. Review: Lithium is associated with adverse events in patients with mood disorders. Ann Intern Med. ;157:JC1–10. doi: 10.7326/0003-4819-157-2-201207170-02010
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Published: Ann Intern Med. 2012;157(2):JC1-10.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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