Review of: Lahteenvuo M et al, JAMA Psychiatry 2018;75(4):347–355

A new study from Finland shows that lithium may be more effective than other treatments in reducing the risk of psychiatric rehospitalization in patients with bipolar disorder.
Using a nationwide Finnish database, the authors examined the risk of rehospitalization for 18,000 patients with bipolar disorder—including psychiatric, cardiovascular, and all-cause hospitalization—from January 1, 1987 to December 31, 2012, then determined the risk of a rehospitalization based on the patients’ use of various medications.

Over the study period, 9,721 of the patients (54%) suffered at least 1 psychiatric rehospitalization. Patients on lithium had the lowest risk for all-cause rehospitalization (hazard ratio [HR] 0.71 [95% CI, 0.66–0.76]), and for psychiatric rehospitalization (HR 0.67 [95% CI, 0.6–0.73]).

In addition to the findings on lithium, researchers also revealed the following about other psychotropic ­treatments:

• Long-acting injectable formulations of antipsychotic medications were more effective than their oral antipsychotic counterparts at reducing the risk of rehospitalization.


• Quetiapine fumarate, the most frequently used antipsychotic treatment in the population, was only modestly effective at reducing the risk of psychiatric rehospitalization.


• Benzodiazepines were linked to an increased risk for both psychiatric and all-cause rehospitalization.

TCPR’s Take
Although most of our treatment guidelines are based on randomized controlled trials, observational studies have many important findings to contribute to evidence-based medicine, and they are an alternative means to gauge effectiveness of various treatments. The study findings correlate well with our clinical and anecdotal experience. Lithium is highly effective for bipolar disorder and should be a first-line treatment; it is also particularly effective for maintenance therapy. Long-acting antipsychotics may be more effective than their corresponding oral agents in preventing rehospitalizations, and we should consider their use whenever feasible. Long-term benzodiazepine use remains risky and problematic.