Long-Term Lithium Therapy for Bipolar Disorder: Systematic Review and Meta-Analysis of Randomized Controlled Trials

John R. Geddes, Sally Burgess, Keith Hawton, Kay Jamison, Guy M. Goodwin

Research output: Contribution to journalArticle


Objective: The authors sought to determine the efficacy and acceptability of lithium for relapse prevention in bipolar disorder. Method: A systematic review and meta-analysis of randomized controlled trials comparing lithium with placebo in the long-term treatment of bipolar disorders was conducted. Data were obtained from searching the registers of the Cochrane Collaboration; reviewing reference lists, journals, and conference abstracts; and contacting authors, experts, and pharmaceutical companies. Outcomes investigated included risk of relapse (manic, depressive, and total) as well as risk of specific adverse effects and total withdrawal rates. Results: Five randomized controlled trials (770 participants) were included. Lithium was more effective than placebo in preventing all relapses (random effects relative risk=0.65, 95% Cl=0.50 to 0.84) and manic relapses (relative risk=0.62, 95% Cl=0.40 to 0.95). The protective effect of lithium on depressive relapses was smaller and was less robust (relative risk= 0.72, 95% Cl=0.49 to 1.07). Conclusions: Lithium treatment reduces the risk of relapse in bipolar disorder. The preventive effect is clear for manic episodes, although it is equivocal for depressive episodes.

Original languageEnglish (US)
Pages (from-to)217-222
Number of pages6
JournalAmerican Journal of Psychiatry
Issue number2
Publication statusPublished - Feb 2004
Externally publishedYes


ASJC Scopus subject areas

  • Psychiatry and Mental health

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