LITHIUM VERSUS QUETIAPINE FOR MAINTENANCE TREATMENT OF BIPOLAR DISORDER: A NARRATIVE REVIEW

Abstract

Introduction: Bipolar disorder is a chronic psychiatric condition characterized by recurrent episodes of mania, hypomania, and depression. Maintenance pharmacotherapy aims to prevent recurrence, reduce hospitalization, and preserve psychosocial functioning. Lithium and quetiapine are among the pharmacological options used in long-term management, although their mechanisms, adverse-effect profiles, monitoring requirements, and supporting evidence differ. Methods: This narrative review examines published literature concerning the clinical effectiveness, tolerability, safety, and economic considerations associated with lithium and quetiapine for the maintenance treatment of bipolar disorder. Relevant literature was identified through searches of PubMed, ScienceDirect, and Google Scholar using combinations of terms related to bipolar disorder, lithium, quetiapine, maintenance treatment, relapse prevention, adverse effects, hospitalization, and cost-effectiveness. The review considered evidence from clinical trials, observational studies, reviews, and clinical practice guidelines. The review was not designed as a systematic review or meta-analysis. Results: Lithium has an established role in maintenance treatment, supported by evidence for recurrence prevention and long-term management. Quetiapine also has evidence supporting maintenance treatment, particularly following stabilization during acute treatment, both as monotherapy and as an adjunct to other mood-stabilizing agents. However, the available evidence does not establish universal superiority of either medication across all clinical outcomes. Differences in study populations, treatment regimens, follow-up periods, and outcome definitions limit direct comparisons. Lithium requires serum concentration monitoring and attention to renal and thyroid function, whereas quetiapine is associated with sedation, weight gain, and metabolic adverse effects. Economic comparisons remain context-dependent, and findings from other healthcare systems cannot automatically be generalized to Indonesia. Discuss: Treatment selection should consider previous treatment response, predominant polarity, recurrence pattern, comorbidities, patient preferences, adherence, safety monitoring, and local healthcare resources. Findings from monotherapy studies should be distinguished from those involving adjunctive treatment, and separate studies should not be compared directly without appropriate qualification. Conclusion: Lithium and quetiapine are relevant options for maintenance treatment of bipolar disorder, but their relative suitability depends on individual clinical circumstances. Treatment decisions should be guided by the available evidence, patient characteristics, tolerability, monitoring requirements, and feasibility of long-term treatment.