Summary of findings 14. Lithium compared to electroconvulsive therapy (ECT) for acute mania.
| Lithium compared to electroconvulsive therapy (ECT) for acute mania | ||||||
| Patient or population: acute mania Setting: inpatients Intervention: lithium Comparison: ECT | ||||||
| Outcomes | Anticipated absolute effects* (95% CI) | Relative effect (95% CI) | № of participants (studies) | Certainty of the evidence (GRADE) | Comments | |
| Risk with ECT | Risk with lithium | |||||
|
Efficacy: response (categorical) YMRS change ≥ 50% from baseline to end of study |
‐ | ‐ | ‐ | ‐ | ‐ | No study measured this outcome |
|
Efficacy: response (continuous) MRS mean change from baseline to end of study |
The mean efficacy: response (continuous) MRS mean change from baseline to end of study in the ECT group was −18.5 | The mean efficacy: response (continuous) MRS mean change from baseline to end of study in the ECT group was −16.4 | ‐ | 34 (1 RCT) | ⊕⊕⊝⊝ Low1 | |
|
Efficacy: remission (categorical) YMRS ≤ 12 at end of study |
‐ | ‐ | ‐ | ‐ | ‐ | No study measured this outcome |
| Acceptability: total withdrawals | ‐ | ‐ | ‐ | ‐ | ‐ | No study measured this outcome |
| Adverse events | ‐ | ‐ | ‐ | ‐ | ‐ | No study measured this outcome |
| *The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: confidence interval; ECT: electroconvulsive therapy; MRS: Mania Rating Scale; OR: odds ratio; YMRS: Young Mania Rating Scale | ||||||
| GRADE Working Group grades of evidence High certainty: we are very confident that the true effect lies close to that of the estimate of the effect. Moderate certainty: we are moderately confident in the effect estimate: the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different. Low certainty: our confidence in the effect estimate is limited: the true effect may be substantially different from the estimate of the effect. Very low certainty: we have very little confidence in the effect estimate: the true effect is likely to be substantially different from the estimate of effect. | ||||||
1Downgraded one level for imprecision. Downgraded one level for suspected publication bias. We only found this one study looking at electroconvulsive therapy in mania. It is not possible to do a funnel plot in this situation.