Quetiapine v. lithium in the maintenance phase following a first episode of mania: randomised controlled trial

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Lithium and quetiapine are considered standard maintenance agents for bipolar disorder yet it is unclear how their efficacy compares with each other.


To investigate the differential effect of lithium and quetiapine on symptoms of depression, mania, general functioning, global illness severity and quality of life in patients with recently stabilised first-episode mania.


Maintenance trial of patients with first-episode mania stabilised on a combination of lithium and quetiapine, subsequently randomised to lithium or quetiapine monotherapy (up to 800 mg/day) and followed up for 1 year. (Trial registration: Australian and New Zealand Clinical Trials Registry – ACTRN12607000639426.)


In total, 61 individuals were randomised. Within mixed-model repeated measures analyses, significant omnibus treatment × visit interactions were observed for measures of overall psychopathology (Brief Psychotic Rating Scale (BPRS), P = 0.005, Clinical Global Impressions – Bipolar, severity, P = 0.006), psychotic symptoms (BPRS, positive symptoms, P = 0.047) and functioning (Global Assessment of Functioning Scale, P = 0.001; Social and Occupational Functioning Scale, P = 0.001). Planned and post hoc comparisons further demonstrated the superiority of lithium treatment over quetiapine.


In people with first-episode mania treated with a combination of lithium and quetiapine, continuation treatment with lithium rather than quetiapine is superior in terms of mean levels of symptoms during a 1-year evolution.

Declaration of interest


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