Summary of findings 15. Lithium compared to all antimanic agents for acute mania.
| Lithium compared to all antimanic agents for acute mania | ||||||
| Patient or population: acute mania Setting: inpatients and specialised outpatient clinics Intervention: lithium Comparison: all antimanic agents | ||||||
| Outcomes | Anticipated absolute effects* (95% CI) | Relative effect (95% CI) | № of participants (studies) | Certainty of the evidence (GRADE) | Comments | |
| Risk with all antimanic agents | Risk with lithium | |||||
|
Efficacy: response (categorical) YMRS/MRS/BPRS change by ≥ 50% at end of study |
Study population | OR 1.36 (1.01 to 1.83) | 3666 (14 RCTs) | ⊕⊕⊕⊕ High | ||
| 395 per 1000 | 476 per 1000 (407 to 545) | |||||
|
Efficacy: response (continuous) YMRS/BPRS: change from baseline to end of study |
The mean efficacy: response (continuous) YMRS/BPRS change from baseline to end of study was 0 | MD 0.30 lower (−1.45 to lower 0.85) | ‐ | 2410 (19 RCTs) | ⊕⊕⊝⊝ Low1 | |
|
Efficacy: remission (categorical) YMRS ≤ 12 at end of study |
‐ | ‐ | ‐ | ‐ | ‐ | No study measured this outcome |
| Acceptability: total withdrawals | Study population | OR 1.16 (0.89 to 1.52) | 4201 (24 RCTs) | ⊕⊕⊕⊕ High | ||
| 308 per 1000 | 341 per 1000 (284 to 404) | |||||
| 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). BPRS: Brief Psychiatric Rating Scale; CI: confidence interval; MD: mean difference; MRS: Mania Rating Scale; OR: odds ratio; RCT: randomised controlled trial; 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 two levels for inconsistency. The overall result of this meta‐analysis is precise, but the individual results are highly heterogeneous. This is probably explainable by small sample sizes in early studies and missing standard deviations that could not be imputed, however, with such a high I2 value (99%) the results could not be said to be consistent.