{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T20:16:18Z","timestamp":1790021778937,"version":"4.0.1"},"reference-count":25,"publisher":"SAGE Publications","issue":"1","license":[{"start":{"date-parts":[[2022,2,15]],"date-time":"2022-02-15T00:00:00Z","timestamp":1644883200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"DOI":"10.13039\/100000133","name":"Agency for Healthcare Research and Quality","doi-asserted-by":"publisher","award":["1R01HS019371-01"],"award-info":[{"award-number":["1R01HS019371-01"]}],"id":[{"id":"10.13039\/100000133","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000025","name":"National Institute of Mental Health","doi-asserted-by":"publisher","award":["NO1MH80001"],"award-info":[{"award-number":["NO1MH80001"]}],"id":[{"id":"10.13039\/100000025","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Aust N Z J Psychiatry"],"published-print":{"date-parts":[[2023,1]]},"abstract":"<jats:sec>\n                    <jats:title>Objective:<\/jats:title>\n                    <jats:p>Patients with bipolar disorder treated with lithium often require additional antipsychotics or anticonvulsants. However, the comparative effectiveness and safety of these agents as add-on to lithium has not been studied.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>This secondary analysis combined two similar 24-week trials on outpatients with bipolar disorder randomized to lithium (target serum level 0.4\u20130.6\u2009mEq\/L). Guideline-based adjunctive antipsychotics (Li+AP) and anticonvulsants (Li+AC) could be used if clinically indicated and was assessed at every study visit. Response was measured on the Clinical Global Impression scale and we performed adjusted mixed effects linear regression analyses. Analysis of variance tests compared metabolic measures including a binary diagnosis of metabolic syndrome before and after 24\u2009weeks of treatment.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>Among 379 outpatients (57% female, mean age 38\u2009years, mean Clinical Global Impression 4.4), users of Li+AP ( N\u2009=\u200950, primarily quetiapine and aripiprazole) improved to a similar degree (mean Clinical Global Impression improvement\u2009=\u20091.6, standard deviation\u2009=\u20091.5) as those using lithium-only (i.e. without adjunctive antipsychotics or anticonvulsants, N\u2009=\u2009149, mean Clinical Global Impression improvement\u2009=\u20091.7, standard deviation\u2009=\u20091.4) ( p\u2009=\u20090.59). Users of Li+AC ( N\u2009=\u2009107, primarily lamotrigine and valproate, mean Clinical Global Impression improvement\u2009=\u20091.2, standard deviation\u2009=\u20091.3) and users of Li+AP+AC ( N\u2009=\u200973, mean Clinical Global Impression improvement\u2009=\u20091.1, standard deviation\u2009=\u20091.3) showed worse response compared to lithium-only users (all p\u2009&lt;\u20090.01). When comparing Li+AP to Li+AC, users of Li+AP improved slightly better on general ( p\u2009=\u20090.05) and manic symptoms ( p\u2009=\u20090.01), but showed a worse development of glucose, triglycerides, and metabolic syndrome.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>Despite treatment-by-indication confounding, these findings are relevant for real-world treatment settings and emphasize the need for randomized trials on this clinically important topic.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/00048674221077619","type":"journal-article","created":{"date-parts":[[2022,2,15]],"date-time":"2022-02-15T03:18:30Z","timestamp":1644895110000},"page":"93-103","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":11,"title":["Lithium plus antipsychotics or anticonvulsants for bipolar disorder: Comparing clinical response and metabolic changes"],"prefix":"10.1177","volume":"57","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5121-1287","authenticated-orcid":false,"given":"Ole","family":"K\u00f6hler-Forsberg","sequence":"first","affiliation":[{"name":"Psychosis Research Unit, Aarhus University Hospital - Psychiatry, Aarhus, Denmark"},{"name":"Department of Clinical Medicine, Aarhus University, Denmark"},{"name":"Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA"},{"name":"Harvard Medical School, Boston, MA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Louisa G","family":"Sylvia","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA"},{"name":"Harvard Medical School, Boston, MA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Thase","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph R","family":"Calabrese","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, Case Western Reserve University, Cleveland, OH, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mauricio","family":"Tohen","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, University of New Mexico Health Sciences Center, Albuquerque, NM, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charles L","family":"Bowden","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, University of Texas Health Science Center, San Antonio, TX, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Melvin","family":"McInnis","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dan V","family":"Iosifescu","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA"},{"name":"Harvard Medical School, Boston, MA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James H","family":"Kocsis","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, Weill Cornell Medical College, New York, NY, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edward S","family":"Friedman","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, University of Pittsburgh Medical Center, Pittsburgh, PA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Terence A","family":"Ketter","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Behavioral Sciences, School of Medicine, Stanford University, Stanford, CA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susan L","family":"McElroy","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, OH, USA"},{"name":"Department of Psychiatry, Lindner Center of HOPE, Mason, OH, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard C","family":"Shelton","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, The University of Alabama at Birmingham, Birmingham, AL, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vicki","family":"Fung","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, Mongan Institute, Massachusetts General Hospital, Boston, MA, USA"},{"name":"Department of Medicine, Harvard Medical School, Boston, MA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael 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