In children and adolescents with bipolar disorder, lithium use was associated with fewer suicide attempts, fewer subthreshold depression symptoms, better psychosocial function, and less parent-reported aggression, according to study results published in the Journal of the American Academy of Child & Adolescent Psychiatry.

Although there is robust data demonstrating the efficacy of lithium as maintenance therapy for adults with bipolar disorder and its superiority over other mood stabilizing medications, support for its use in youth is limited.

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Danella M. Hafeman, MD, PhD, of The University of Pittsburgh, Pennsylvania, and colleagues used data from the Course and Outcome of Bipolar Youth study to determine whether lithium was associated with improvements in mood symptoms and suicidality in children and adolescents compared with other mood stabilizing medication. The naturalistic longitudinal study comprised 413 youth with bipolar disorder who were between the age of 7 and 17.11 years at study entry.

The study used data from 340 patients who contributed 2638 six-month follow-up periods; 139 patients were taking lithium with or without other mood stabilizing medication, and 201 were taking other mood stabilizing medication without lithium. The mean follow-up was 10 years.

Patients using lithium were less likely to have lifetime anxiety and be using antidepressants (P <.005 for both variables) than patients on other mood stabilizing medication. They were also half as likely to attempt suicide (P =.03) and had fewer depressive symptoms (P =.004), less psychosocial impairment (P =.003), and less aggression (P =.0004).

The investigators noted that the results of this study are consistent with those from previous studies, primarily in adults, demonstrating improvement in mood course and reduction in suicide attempts and aggression. However, lithium did not appear to be superior to other mood stabilizing medication for hypomanic and manic episodes. The investigators suggested that the advantages of lithium for hypomanic and manic symptoms may not be as evident in earlier onset bipolar disorder.

The observational nature of this study limited the investigators’ ability to assess other effects of medication (eg, the effect of polypharmacy or antidepressants).

“Future work should focus on (1) elucidating the mechanisms by which [lithium] improves outcomes in [bipolar disorder], so that novel therapeutics can be developed to target these mechanisms with fewer side effects; and (2) identifying who will best respond to [lithium], to optimize the risk-benefit ratio,” the investigators concluded.

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.

Reference

Hafeman DM, Rooks B, Merranko J, et al. Lithium versus other mood stabilizing medications in a longitudinal study of bipolar youth [published online July 29, 2019]. J Am Acad Child Adolesc Psychiatry. doi.org/10.1016/j.jaac.2019.06.013