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Observational Study
. 2018 Feb 7;18(1):37.
doi: 10.1186/s12888-018-1622-1.

Reasons for lithium discontinuation in men and women with bipolar disorder: a retrospective cohort study

Louise Öhlund  1 , Michael Ott  2 , Sofia Oja  3 , Malin Bergqvist  4 , Robert Lundqvist  5 , Mikael Sandlund  6 , Ellinor Salander Renberg  6 , Ursula Werneke  7   8
Affiliations
Observational Study

Reasons for lithium discontinuation in men and women with bipolar disorder: a retrospective cohort study

Louise Öhlund et al. BMC Psychiatry. .

Erratum in

Abstract

Background: Lithium remains first choice as maintenance treatment for bipolar affective disorder. Yet, about half of all individuals may stop their treatment at some point, despite lithium's proven benefits concerning the prevention of severe affective episodes and suicide.

Methods: Retrospective cohort study in the Swedish region of Norrbotten into the causes of lithium discontinuation. The study was set up to (1) test whether patients with bipolar affective disorder or schizoaffective disorder, treated with lithium maintenance therapy, were more likely to discontinue lithium because of adverse effects than lack of therapeutic effectiveness, (2) explore gender differences, (3) understand the role of diagnosis and (4) identify who, patient or doctor, took the initiative to stop lithium. Review of medical records for all episodes of lithium discontinuation that had occurred between 1997 and 2013 with the intent to stop lithium for good.

Results: Of 873 patients treated with lithium, 54% discontinued lithium, corresponding to 561 episodes of lithium discontinuation. In 62% of episodes, lithium was discontinued due to adverse effects, in 44% due to psychiatric reasons, and in 12% due to physical reasons interfering with lithium treatment. The five single most common adverse effects leading to lithium discontinuation were diarrhoea (13%), tremor (11%), polyuria/polydipsia/diabetes insipidus (9%), creatinine increase (9%) and weight gain (7%). Women were as likely as men to take the initiative to stop lithium, but twice as likely to consult a doctor before taking action (p < 0.01). Patients with type 1 BPAD or SZD were more likely to discontinue lithium than patients with type 2 or unspecified BPAD (p < 0.01). Patients with type 1 BPAD or SZD were more likely to refuse medication (p < 0.01). Conversely, patients with type 2 or unspecified BPAD were three times as likely to discontinue lithium for lack or perceived lack of effectiveness (p < 0.001).

Conclusions: Stopping lithium treatment is common and occurs mostly due to adverse effects. It is important to discuss potential adverse effects with patients before initiation and continuously during lithium treatment, to reduce the frequency of potentially unnecessary discontinuations.

Keywords: Bipolar disorder; Compliance; Lithium; Physical health; Side effects.

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Conflict of interest statement

Ethics approval and consent to participate

The Regional Ethics Review Board at Umeå University, Sweden, had approved this study (DNR 2010-227-31M, DNR 2011-228-32M, DNR 2014-10-32M). All participants provided verbal informed consent.

Consent for publication

Not applicable.

Competing interests

Ursula Werneke has received funding for educational activities on behalf of Norrbotten Region (Masterclass Psychiatry Programme, EAPM 2016 Luleå, Sweden): Astra Zeneca, Janssen, Eli Lilly, Novartis, Otsuka/Lundbeck, Servier, Sunivion and Shire.

Louise Öhlund, Michael Ott, Sofia Oja, Malin Bergqvist, Robert Lundqvist, Mikael Sandlund and Ellinor Salander Renberg declare that there is no conflict of interest.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Selection of study sample
See this image and copyright information in PMC

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