Lithium Versus Other Mood-Stabilizing Medications in a Longitudinal Study of Youth Diagnosed With Bipolar Disorder - 25/09/20
, Brian Rooks, PhD b, John Merranko, MA a, Fangzi Liao, MS a, Mary Kay Gill, MSN a, Tina R. Goldstein, PhD a, Rasim Diler, MD a, Neal Ryan, MD a, Benjamin I. Goldstein, MD c, David A. Axelson, MD d, Michael Strober, PhD e, Martin Keller, MD f, Jeffrey Hunt, MD f, Heather Hower, MSW f, Lauren M. Weinstock, PhD f, Shirley Yen, PhD f, Boris Birmaher, MD aAbstract |
Objective |
Lithium is the mainstay for bipolar disorder (BD) treatment in adults, but evidence in youths is limited. We used data from the Course and Outcome of Bipolar Youth (COBY) study to assess whether lithium vs other mood-stabilizing medication (OMS) was associated with improved outcomes, including mood symptoms and suicidality.
Method |
COBY is a naturalistic, longitudinal study of 413 youths, 7 to 17.11 years old at intake, with BD. At each visit, medication exposure, psychiatric symptoms, and psychosocial function over the preceding follow-up period were assessed using the Adolescent Longitudinal Interval Follow-Up Evaluation. Using mixed models, we determined whether participants taking lithium vs OMS (but not lithium) differed regarding mood symptoms, suicidality, psychosocial function, hospitalization, aggression, and substance use.
Results |
A total of 340 participants contributed 2,638 six-month follow-up periods (886 lithium, 1,752 OMS), over a mean follow-up of 10 years. During lithium (vs OMS) follow-up periods, participants were older, less likely to have lifetime anxiety, and less likely to be on antidepressants (p values<.005). After covariate adjustment, the lithium group (vs OMS) had half as many suicide attempts (p = .03), fewer depressive symptoms (p = .004), less psychosocial impairment (p = .003), and less aggression (p = .0004). Similar findings were observed in the subgroup of follow-up periods in which participants were <18 years old.
Conclusion |
Findings are consistent with adult studies, showing that lithium is associated with decreased suicidality, less depression, and better psychosocial functioning. Given the paucity of evidence regarding lithium in children and adolescents, these findings have important clinical implications for the pharmacological management of youths with BD.
Le texte complet de cet article est disponible en PDF.Key words : bipolar disorder, child and adolescent, lithium, mood-stabilizing medications, suicidality
Plan
| This research was supported by National Institute of Mental Health (NIMH) grants MH59929 (PI Boris Birmaher, MD), MH59977 (PI Michael Strober, PhD), MH59691 (PI Martin Keller, MD, and Shirley Yen, PhD), and MH110421 (PI Danella Hafeman, MD, PhD). |
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| Dr. Rooks and Mr. Merranko served as the statistical experts for this research. |
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| Disclosure: Dr. Hafeman has received grants from NIMH and the Klingenstein Third Generation Foundation. Dr. T. Goldstein has received grants from NIMH, the American Foundation for Suicide Prevention (AFSP), and the Brain and Behavior Foundation and royalties from Guilford Press. Dr. Diler has received research support from NIMH. Dr. Ryan has received grants from the National Institutes of Health (NIH). Dr. B. Goldstein has received research support from Brain Canada, the Canadian Institutes for Health Research, the Heart and Stroke Foundation, NIMH, the Sunnybrook Hospital Department of Psychiatry, and the University of Toronto Department of Psychiatry. Dr. Axelson has received grants from NIMH and personal fees from Janssen Research and Development, LLC, and UpToDate. Dr. Strober has received research support from NIMH and as the Resnick Endowed Chair in Eating Disorders at the University of California, Los Angeles. Dr. Keller has received research support from NIMH. Dr. Hunt has received honorarium from Wiley Publishers and has received support from the NIMH. Dr. Weinstock has received funding from the National Center for Complementary and Integrative Health (NCCIH), NIMH, the NIH Office of Behavioral and Social Sciences Research, and the National Institute of Justice. Dr. Yen has received research support from NIMH, NICCH, and AFSP and has served as a consultant at Janssen Global Services. Dr. Birmaher has received grants from NIMH and royalties from Random House, UpToDate, and Lippincott, Williams and Wilkins. Ms. Hower has received funding from NIMH and honoraria from the US Department of Defense. Dr. Rooks, Mr. Merranko, Ms. Liao, and Ms. Gill have reported no biomedical financial interests or potential conflicts of interest. |
Vol 59 - N° 10
P. 1146-1155 - octobre 2020 Retour au numéro
Article précédent
- White Matter Microstructure in Pediatric Bipolar Disorder and Disruptive Mood Dysregulation Disorder
- Julia O. Linke, Nancy E. Adleman, Joelle Sarlls, Andrew Ross, Samantha Perlstein, Heather R. Frank, Kenneth E. Towbin, Daniel S. Pine, Ellen Leibenluft, Melissa A. Brotman
- Predicting Personalized Risk of Mood Recurrences in Youths and Young Adults With Bipolar Spectrum Disorder
- Boris Birmaher, John A. Merranko, Mary Kay Gill, Danella Hafeman, Tina Goldstein, Benjamin Goldstein, Heather Hower, Michael Strober, David Axelson, Neal Ryan, Shirley Yen, Rasim Diler, Satish Iyengar, Michael W. Kattan, Lauren Weinstock, Martin Keller
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