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A Pilot Study of the Effectiveness of Lithium Versus Quetiapine Immediate Release Monotherapy in Patients With Bipolar Spectrum Disorders

Gao, Keming MD, PhD; Goto, Toyomi MA; Yuan, Chengmei MD, PhD; Brownrigg, Brittany BS; Conroy, Carla MPH; Chan, Philip K. PhD; Serrano, Mary Beth MA; Ganocy, Stephen J. PhD; Fang, Fang MD, MS; Calabrese, Joseph R. MD

Journal of Clinical Psychopharmacology: October 2018 - Volume 38 - Issue 5 - p 422–434
doi: 10.1097/JCP.0000000000000927
Original Contributions

Objective The aim of this study was to compare the effectiveness of lithium versus quetiapine immediate release (IR) monotherapy in patients with bipolar I, II, or subthreshold bipolar disorder at any phase.

Methods Eligible patients were randomized to lithium or quetiapine IR for 16 weeks. The difference in the time to discontinuation from study due to “all causes” between lithium and quetiapine IR groups and changes from baseline to 8 and 16 weeks in depression, mania, anxiety, quality of life (QOL), metabolic profiles, and proinflammatory markers were compared.

Results Of the 42 patients randomized to lithium (n = 18) and quetiapine IR (n = 24), the median time to discontinuation due to “all causes” was 6 weeks (95% confidence interval, 2–12 weeks) in the lithium group and 8 weeks (95% confidence interval, 6 weeks to not calculable) in the quetiapine IR group. The mean time to discontinuation due to “all causes” was 7.7 ± 1.1 weeks for lithium versus 8.4 ± 0.8 weeks for quetiapine IR (P = 0.54). There was no significant difference between lithium and quetiapine IR in changes in the severity of depression, mania/hypomania, anxiety, and QOL as a whole or only in patients with depressive index episode. The decrease in total cholesterol was significantly larger with lithium than with quetiapine IR (P = 0.05) as a whole, but not only in patients with depression index episode. There was no other significant difference in changes in metabolic panels and inflammatory markers between the 2 groups.

Conclusions The difference in effectiveness between lithium and quetiapine IR monotherapy in a real-world bipolar population was minimal. Large-sample studies are needed to support or refute this finding.

From the Mood and Anxiety Clinic in the Mood Disorders Program, Department of Psychiatry, Case Western Reserve University School of Medicine/University Hospitals Cleveland Medical Center, Cleveland, OH.

Received March 3, 2017; accepted after revision June 20, 2018.

Reprints: Keming Gao, MD, PhD, 10524 Euclid Ave, 12 Floor, Cleveland, OH 44106 (e-mail:

C.Y. is now with the Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China. F.F. is now with the Mood Disorders Program, Hongkou District Mental Health Center of Shanghai, Shanghai, China.

This study was supported by a grant of the Young Investigator Award from Brain and Behavior Research Foundation and a grant from Cleveland Foundation.

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