Speaker 1: Herbert Meltzer, USA

Introduction: First-episode mania (FEM) is the first feasible diagnostic and therapeutic opportunity. Lithium is established as a first-line treatment for bipolar disorder. More recently antipsychotic drugs including quetiapine have been found to be effective in the treatment of mania, depression and in maintenance. However, the comparative benefits of these agents in the maintenance phase after a first episode of mania are unclear. This study compared the differential clinical effect of Lithium and Quetiapine after a first episode of mania. Method: The study was a single-blind, randomised controlled trial of 61 participants in remission from a first episode of severe mania. Participants were stabilised on the combination of lithium or quetiapine and were then randomised to either agent as maintenance treatment over a 12-month follow-up period. The groups were compared on performance outcomes using an extensive clinical battery including mood, functioning, psychotic and quality of life measures conducted at baseline, month 3 and month 12 follow-up time-points. Results: At endpoint, there was an advantage for lithium over quetiapine on measures of depression, psychosis and global impression. Conclusion: This study suggests that in a group of young individuals with a first episode of mania, lithium may have clinical advantages over quetiapine over the maintenance phase. This data is in contrast to some published reports suggesting broad equivalence, and raises questions about stage specific patterns of response as well as differential efficacy in classic severe mania.