Comparing measurements of lithium treatment efficacy in people with bipolar disorder: systematic review and meta-analysis – CORRIGENDUM

This article originally published with errors in figure 1 and tables 1 and 3. The correct figure and tables are included below.

Fig. 1.

Prisma flow chart

Table 1.

Characteristics of studies

	Overall results (n = 71)		RCT (n = 33)		Non-randomised 2 arm studies (n = 13)		Non-randomised 1 arm studies (n = 25)
	N	%	N	%	N	%	N	%
Study characteristics
Location
North America	28	39.4	14	42.4	4	30.8	10	40.0
Middle America	0	0	0	0	0	0	0	0
South America	10	14.1	1	3.0	0	0	9	36.0
Europe	17	23.9	4	12.1	8	61.5	5	20.0
Africa	3	4.2	3	9.1	0	0	0	0
Asia	9	12.7	7	21.2	1	7.7	1	4.0
Australia	1	1.4	1	3.0	0	0	0	0
Multiple	3	4.2	3	9.1	0	0	0	0
Setting
Outpatient	33	46.5	15	45.5	5	38.5	13	52.0
Inpatient	14	19.7	10	30.3	1	7.7	3	12.0
Community	2	2.8	2	6.1	0	0	0	0
Multiple	17	23.9	6	18.2	5	38.5	6	24.0
n/r	5	7.0	0	0	2	15.4	3	12.0
Study design
RCT	26	36.6%	26	78.8%	0	0%	0	0%
Cross-over	0	0%	0	0%	0	0%	0	0%
Naturalistic studies	9	12.7%	0	0%	4	30.8%	5	20%
Retrospective cohort	1	1.4%	0	0%	1	7.7%	0	0%
Open label lithium	26	36.6%	5	15.2%	3	23.1%	18	72%
Other/register	7	9.9%	0	0%	5	38.5%	2	8%
Multiple	2	2.8%	2	6.1%	0	0%	0	0%
Population
BD1	23	32.4	17	51.1	2	15.4	4	16.0
BD2	6	8.5	6	18.2	0	0	0	0
BD mix	38	53.5	8	24.2	11	84.6	19	76.0
BD and other	3	4.2	2	6.1	0	0	1	4.0
n/r	1	1.4	0	0	0	0	1	4.0
Current episode
Manic/hypomanic	13	18.3	12	36.4	0	0	1	4.0
Depression	17	23.9	4	12.1	0	0	13	52.0
Euthymic	4	5.6	3	9.1	1	7.7	0	0
Other/mix	18	25.4	8	24.2	7	53.8	3	12.0
Multiple	13	18.3	5	15.2	3	23.1	5	20.0
n/r	6	8.5	1	3.0	2	15.4	3	12.0
Diagnostic tool
DSM	55	77.5	27	81.8	6	46.2	22	88.0
ICD	8	11.3	2	6.1	5	38.5	1	4.0
Other	3	4.2	1	3.0	1	7.7	1	4.0
Multiple	2	2.8	2	6.1	0	0	0	0
n/r	3	4.2	1	3.0	1	7.7	1	4.0
Participants, total (mean)	30542 (430.2)		4918 (149.0)		24052 (1850.2)		1572 (62.9)
Study length, months	13.9		8.8		39.6		8.3
Participants characteristics
Age, years (mean or median when only available)	37.5		37.5		43.4		34.5
Female, mean %		53.7		50.1		51.9		59.9
Anxiety comorbidity exclusion
Yes	22	31.0	7	21.2	1	7.7	14	56.0
No	49	69.0	26	78.8	12	92.3	11	44.0
Substance misuse comorbidity exclusion
Yes	48	67.6	25	75.8	2	15.4	21	84.0
No	23	32.4	8	24.2	11	84.6	4	16.0
Psychosis comorbidity exclusion
Yes	26	36.6	9	27.3	4	30.8	13	52.0
No	45	63.4	24	72.7	9	69.2	12	48.0
Suicide ideation exclusion
Yes	15	21.1	11	33.3	0	0	4	16.0
No	56	78.9	22	66.7	13	100.0	21	84.0

N = number of studies; RCT = randomised control studies; BD = bipolar disorder; DSM = Diagnostic and Statistical Manual of Mental Disorders; ICD = International Classification of Diseases

Table 3.

Meta-analysis of primary outcome

	Depression						Mania						Global impression
Subgroup	K	N	ES	SE	95% CI	I2	k	N	ES	SE	95% CI	I2	k	N	ES	SE	95% CI	I2
All	18	507	1.56	0.19	1.19–1.94	90%	23	814	1.85	0.20	1.46–2.25	94%	14	516	0.99	0.13	0.73–1.25	87%
RCT vs non-RCT
RCT	6	30	0.8	0.1	0.49–1.19	86	16	68	1.49	0.20	1.10–1.98	94%	10	399	0.94	0.13	0.69–1.19	81%
NRT	12	200	1.94	0.27	1.42–2.46	79%	7	126	3.47	0.98	1.56–5.38	95%	4	117	1.18	0.44	0.32–2.04	94%
Baseline affective state
Depressed	9	17	2.07	0.30	1.49–2.66	79%
Manic							11	29	2.97	0.43	2.13–3.81	95%
Mixed	9	326	0.91	0.17	0.59–1.24	82%	10	446	1.19	0.20	0.80–1.58	90.0%
Duration
Low (<2 months)	9	232	1.60	0.30	1.01–2.20	91%	13	344	2.38	0.36	1.68–3.07	96%
Moderate (2–6 months)	8	267	1.68	0.34	1.02–2.35	91%	8	418	1.24	0.20	0.85–1.63	87%
Hight (>6 months)	1	8	0.7	0.36	0.0–1.41	0%	2	52	1.15	1.23	−1.3–3.56	92%
BD type
BD1 only	3	94	0.72	0.26	0.20–1.23	68%	14	520	2.22	0.29	1.66–2.78	95%	7	220	0.93	0.24	0.46–1.4	92%
BD2 only	2	52	3.07	0.30	2.49–3.66	0%	1	12	1.10	0.25	0.06–1.59	0.0%	1	12	0.86	0.32	0.23–1.49	0.0%
Studies including mixture	12	382	1.55	0.24	1.09–2.01	87%	8	310	1.07	0.24	0.60–1.54	86%	6	284	1.06	0.17	0.73–1.39	83%

K = number of studies; N = number of participants combined in included studies; ES = Effect size; SE = Standard error; CI = confidence interval; I² = heterogeneity; RCT = randomised controlled trial; BD = bipolar disorder