Is lithium better than quetiapine in treating bipolar depression?

In a recent study published in Neuropsychopharmacology Reports, the results verified that the safety and effectiveness of lithium and quetiapine for treating bipolar depression were the same.

According to a global mental health study, bipolar illness is a severe chronic mood disorder with a lifetime incidence of around 1%. Bipolar disorder is frequently diagnosed later, which has negative social and financial effects on the individuals. Different recommendations prescribe different pharmaceutical therapies for bipolar depression. In this investigation, Masaya Ogasawara and colleagues investigated the effectiveness and security of mood stabilizers and antipsychotics for bipolar depression.

For this study the search for reports of RCTs was conducted in the electronic databases of ClinicalTrials.gov (search date: March 3, 2021), Embase (search date: March 4, 2021), Cochrane Central Register of Controlled Trials (CENTRAL; search date: March 4, 2021), and PubMed (search date: March 3, 2021).

The rate of remission from depressive episodes (from baseline to up to 4 months of follow-up) served as the major end measure. A prior study was used to determine the study duration. The following were some of the secondary outcome measures: (2) alterations in the severity of depressive symptoms; (3) adjustments to social functioning; (4) suicide-related incidents; (5) grave adverse incidents; (6) dropouts as a result of adverse incidents; and (7) dropouts for any reason. The MADRS or HAM-D17 were both used to assess depressive symptoms. The Sheehan Disability Scale was used to assess social function (SDS).

The key findings of this study were as follow:

1. No further antipsychotic-mood stabilizer combinations were discovered; instead, three papers combining quetiapine with lithium were located and examined.

2. For the following outcomes: (1) remission from depressive episodes, (2) changes in depressive symptoms, (3) changes in social function, (4) suicide-related events, (5) severe adverse events, and (6) dropouts due to adverse events dropout for any reason, the meta-analysis found no significant differences between quetiapine and lithium.

In conclusion, this meta-analysis found no distinction between lithium and quetiapine in terms of effectiveness or safety for treating bipolar depression. It is unclear whether antipsychotics or mood stabilizers are more beneficial for treating bipolar depression, and further research is required, particularly when comparing antipsychotics and mood stabilizers other than quetiapine with lithium.

Reference: 

Ogasawara, M., Takeshima, M., Esaki, Y., Kaneko, Y., Utsumi, T., Aoki, Y., Watanabe, N., Suzuki, M., & Takaesu, Y. (2022). Comparison of the efficacy and safety of quetiapine and lithium for bipolar depression: A systematic review and meta‐analysis of randomized controlled trials. In Neuropsychopharmacology Reports. Wiley.https://doi.org/10.1002/npr2.12283