Lithium Versus Other Mood-Stabilizing Medications in a Longitudinal Study of Youth Diagnosed With Bipolar Disorder
Open accessAbstract
Objective: Lithium (LI) is the mainstay for bipolar disorder (BD) treatment in adults, but evidence in youth is limited. We used data from the Course and Outcome of Bipolar Youth (COBY) study to assess whether LI 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 youth, 7–17.11 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 LI vs. OMS (but not LI) differed regarding mood symptoms, suicidality, psychosocial function, hospitalization, aggression, and substance use. Results: 340 participants contributed 2638 six-month follow-up periods (886 LI, 1752 OMS), over a mean follow-up of ten years. During LI (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 LI 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 where participants were <18 years old. Conclusion: Findings are consistent with adult studies, showing that LI 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 youth with BD.
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- Authors
- Hafeman, D. M., Rooks, B., Merranko, J., Liao, F., Gill, M. K., Goldstein, T. R., Diler, R., Ryan, N., Goldstein, B. I., Axelson, D. A., Strober, M., Keller, M., Hunt, J., Hower, H., Weinstock, L. M., Yen, S., & Birmaher, B.
- Affiliations
- University of Pittsburgh (US)
- University of Rochester Medicine (US)
- Sunnybrook Health Science Centre (CA)
- Nationwide Children's Hospital (US)
- University of California, Los Angeles (US)
- Brown University (US)
- Corresponding author
- Hafeman, Danella M.
- ORCID
- Venue
- Journal of the American Academy of Child & Adolescent Psychiatry
- Publisher
- Elsevier BV
- Published
- 2020-10
- Volume
- 59
- Issue
- 10
- Pages
- 1146-1155
- ISSN
- 0890-8567 (ISSN-L)
- PMC
- PMC6987013
- OpenAlex
- W2966843539
- Semantic Scholar
- 186423a52bf5187c4765185ba561046269316719
- Cited by
- 83
- References
- 31
- Citations by year
- 2026: 11 · 2025: 4 · 2024: 18 · 2023: 17 · 2022: 12 · 2021: 14 · 2020: 6 · 2019: 1
- FWCI
- 6.47
- Type
- journal article
- Language
- en
- Open access
- green
- europepmc.org
- Locations
- Journal of the American Academy of Child & Adolescent Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- eScholarship (California Digital Library) (submittedVersion)
- Funders
- National Institute of Mental Health
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Bipolar Disorder and Treatment
- Social Sciences › Psychology › Clinical Psychology › Personality Disorders and Psychopathology
- Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
- Keywords
- lithium, bipolar disorder, youth, suicidality, suicide attempts, depressive symptoms, psychosocial functioning, aggression, hospitalization, substance use, antidepressants
- MeSH terms
- Adolescent, Affect, Anxiety Disorders, Bipolar Disorder, Child, Humans, Lithium, Longitudinal Studies
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