Authors: Kleindienst N and Greil W.
Title: Differential efficacy of lithium and carbamazepine in the prophylaxis of bipolar disorder: results of the MAP study.
Reference: Neuropsychiobiology 2000;42(Suppl 1):2-10.
Purpose: To investigate the efficacy of carbamazepine and lithium in sub-samples of bipolar disorder in the MAP study.
Study design: A randomized, clinical trial.
Follow up: 2.5 years.
Patients: 171 patients (86 lithium, 85 carbamazepine).
Treatment: Average doses during maintenance phase: lithium 26.8 + 6.76 mmol/day (serum level of 0.61 + 0.12 mmol/L), carbamazepine 635 + 190 mg/day (serum level of 6.12 + 1.27 mcg/mL).
Results: In bipolar I disorder (114 patients), lithium was superior to carbamazepine. In bipolar II, the two drugs were equally effective. In classical bipolar patients (no mood incongruent delusions or comorbidity), there was a significantly lower rate of hospitalization with lithium compared with carbamazepine. There was a positive association between hospitalization and the number of non-classical features in the lithium group (p = 0.035) and carbamazepine group (p = 0.033). Patients with an episode sequence of mania»depression»free interval responded better to lithium than carbamazepine. A trend in favor of lithium was found regarding suicidal behaviour. Patient satisfaction was significantly greater in the carbamazepine group.