Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2017 Mar 9:13:755-766.
doi: 10.2147/NDT.S126708. eCollection 2017.

Lithium in late-life mania: a systematic review

Pasquale De Fazio  1 , Raffaele Gaetano  1 , Mariarita Caroleo  1 , Maria Pavia  2 , Giovanbattista De Sarro  3 , Andrea Fagiolini  4 , Cristina Segura-Garcia  1
Affiliations
Review

Lithium in late-life mania: a systematic review

Pasquale De Fazio et al. Neuropsychiatr Dis Treat. .

Abstract

The prevalence of mania among >65-year-olds ranges from 0.1% to 0.4% and its treatment is a particular challenge for clinicians. Although lithium is the treatment of choice for bipolar disorder (BD), its use in elderly population was recently questioned. This study provides a comprehensive review of literature on the efficacy and tolerability of lithium as a pharmacologic treatment for mania in elderly BD patients. We conducted a systematic review, based on PRISMA guidelines, of articles published between 1970 and August 2016 and indexed in the following databases: EMBASE, MEDLINE, Cochrane Library Databases and PsycINFO. The key words "age", "late-life", "geriatric", "elderly", and "older" were combined with words indicating pharmacologic treatments, such as lithium and other mood stabilizers and with the diagnostic terms "bipolar disorder" and "mania". Fifteen out of 196 retrieved studies met our inclusion criteria. Seven studies evaluated both the efficacy and tolerability of lithium treatment in elderly BD patients; a further three evaluated only the efficacy and five assessed tolerability. Only limited data on the treatment of elderly BD patients are available, but evidence suggests that lithium is effective and tolerated in this subgroup of patients and thus should remain a first-line drug. It seems to be more effective at lower doses and close monitoring of plasma concentrations is necessary.

Keywords: bipolar disorder; efficacy; elderly; late-life mania; lithium; tolerability.

PubMed Disclaimer

Conflict of interest statement

Disclosure The authors report no conflicts of interest in this work.

Figures

Figure 1
Figure 1
PRISMA flow diagram. Abbreviation: BD, bipolar disorder.
See this image and copyright information in PMC

Similar articles

  • Lithium for acute mania.
    McKnight RF, de La Motte de Broöns de Vauvert SJGN, Chesney E, Amit BH, Geddes J, Cipriani A. McKnight RF, et al. Cochrane Database Syst Rev. 2019 Jun 1;6(6):CD004048. doi: 10.1002/14651858.CD004048.pub4. Cochrane Database Syst Rev. 2019. PMID: 31152444 Free PMC article.
  • Treatments for late-life bipolar disorder.
    Aziz R, Lorberg B, Tampi RR. Aziz R, et al. Am J Geriatr Pharmacother. 2006 Dec;4(4):347-64. doi: 10.1016/j.amjopharm.2006.12.007. Am J Geriatr Pharmacother. 2006. PMID: 17296540 Review.
  • [Antipsychotics in bipolar disorders].
    Vacheron-Trystram MN, Braitman A, Cheref S, Auffray L. Vacheron-Trystram MN, et al. Encephale. 2004 Sep-Oct;30(5):417-24. doi: 10.1016/s0013-7006(04)95456-5. Encephale. 2004. PMID: 15627046 Review. French.
  • Valproate for acute mania.
    Jochim J, Rifkin-Zybutz RP, Geddes J, Cipriani A. Jochim J, et al. Cochrane Database Syst Rev. 2019 Oct 7;10(10):CD004052. doi: 10.1002/14651858.CD004052.pub2. Cochrane Database Syst Rev. 2019. PMID: 31621892 Free PMC article. Review.
  • [Guidelines for the prescription of mood stabilizers for adolescents: A literature review].
    Munch G, Godart N. Munch G, et al. Encephale. 2017 Oct;43(5):464-470. doi: 10.1016/j.encep.2016.09.005. Epub 2016 Nov 18. Encephale. 2017. PMID: 27871720 Review. French.
See all similar articles

Cited by

See all "Cited by" articles

References

    1. American Psychiatric Association . DSM-V Diagnostic and Statistic Manual of Mental Disorders. Milano: Masson; 2013.
    1. Jansen K, Magalhães PV, Tavares Pinheiro R, Kapczinski F, Silva RA. Early functional impairment in bipolar youth: a nested population-based case-control study. J Affect Disord. 2012;142(1–3):208–212. - PubMed
    1. Gutierrez-Rojas L, Gurpegui M, Ayuso-Mateos JL, Gutierrez-Ariza JA, Ruiz-Veguilla M, Jurado D. Quality of life in bipolar disorder patients: a comparison with a general population sample. Bipolar Disord. 2008;10(5):625–634. - PubMed
    1. Merikangas KR, Akiskal HS, Angst J, et al. Lifetime and 12-month prevalence of bipolar spectrum disorder in the National Comorbidity Survey replication. Arch Gen Psychiatry. 2007;64(5):543–552. - PMC - PubMed
    1. Kessler RC, Ormel J, Petukhova M, et al. Development of lifetime comorbidity in the World Health Organization world mental health surveys. Arch Gen Psychiatry. 2011;68(1):90–100. - PMC - PubMed

LinkOut - more resources