Lithium monotherapy may be safe and effective for treating acute mania and preventing mood instability in children and adolescents with bipolar disorder, according to study results published in European Psychiatry.

In this systematic review, researchers searched major databases for studies that included children and adolescents who were treated with either lithium monotherapy or lithium in combination with other psychoactive therapies for bipolar disorder. After applying the search criteria, the investigators found 30 studies that included a total of 12 randomized trials. The majority of studies were short-term, being conducted for less than 8 weeks, with the exception of one that continued for more than 6 months.

In terms of efficacy, 3 randomized controlled trials demonstrated that treatment with lithium monotherapy improved overall functioning and symptoms of mania or mixed mania in children and adolescents with bipolar illness. One trial showed more than 50% of participants meeting response and remission criteria. In addition, other observational studies reported efficacy for lithium as maintenance therapy, notably in patients who benefited from acute therapy with lithium.

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With respect to safety, lithium was considered to be primarily safe for short-term use. The most common adverse events reported were gastrointestinal upset, headache, and polyuria.

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Limitations of this systematic review included the short duration of follow-up and small sample size.

“Though the available literature is mostly short-term, there is evidence that lithium monotherapy is reasonably safe and effective in children and adolescents, specifically for acute mania and for prevention of mood episodes,” the researchers wrote.

Disclosures: Dr Amerio, Dr Ossola, Dr Scagnelli, Dr Odone, Dr Allinovi, Dr Cavalli, Dr Iacopelli, Dr Tonna, and Dr Marchesi report no conflicts of interest. Dr Ghaemi has provided research consulting to Sunovion in the past year, and is employed by Novartis Institutes for Biomedical Research. Neither he nor his family hold equity positions in pharmaceutical corporations.


Amerio A, Ossola P, Scagnelli F, et al. Safety and efficacy of lithium in children and adolescents: A systematic review in bipolar illness. European Psychiatry. 2018;54:85-97.