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. 2021 Mar 9;9(1):10.
doi: 10.1186/s40345-020-00215-z.

Overview of lithium's use: a nationwide survey

Xabier Pérez de Mendiola  1   2 , Diego Hidalgo-Mazzei  3 , Eduard Vieta  3 , Ana González-Pinto  4   3
Affiliations

Overview of lithium's use: a nationwide survey

Xabier Pérez de Mendiola et al. Int J Bipolar Disord. .

Erratum in

  • Correction: Overview of lithium's use: a nationwide survey.
    Pérez de Mendiola X, Hidalgo-Mazzei D, Vieta E, González-Pinto A. Pérez de Mendiola X, et al. Int J Bipolar Disord. 2024 Jul 25;12(1):26. doi: 10.1186/s40345-024-00343-w. Int J Bipolar Disord. 2024. PMID: 39048734 Free PMC article. No abstract available.

Abstract

Background: Lithium is considered the gold standard treatment for bipolar disorder (BD). Current clinical guidelines and scientific evidence support its use as a first-line treatment in BD. However, over the last two decades, there has been a downward tendency in lithium's use in several developed countries. Based on a nationwide survey, this study's objective is to analyze in a large sample of psychiatrists relevant issues of the use of lithium salts in BD.

Methods: Data were collected through an anonymous survey sent by email among 500 psychiatrists who belong to a National Society of Psychiatry (Spanish Society of Biological Psychiatry). The survey is a self-administered questionnaire consisting of 21 items on the most key aspects of lithium's use (indication, dosage, monitoring, and information for patients).

Results: 212 psychiatrists completed the survey. 70% of psychiatrists prescribe lithium to more than 50% of patients diagnosed with BD. Adverse effects are the main reason not to use lithium salts. Over 75% of the participants consider lithium salts the treatment of choice for the maintenance phase of BD, both in women and men. Most of the participants (> 50%) start lithium after the first affective episode, use conservative plasma concentrations (0.6-0.8 mmol/L), and generally prescribe it twice a day. 57% of psychiatrists who treat patients under 18 do not use lithium in this population. About 70% of the survey respondents use official protocols to inform and monitor patients on lithium treatment.

Conclusions: From the results of the present study, it can be concluded that the use of lithium in Spain is in line with the recommendations of the main international clinical guidelines and current scientific literature. The first reason not to prescribe lithium in our country is the perception of its adverse effects and not the aspects related to its practical use or its effectiveness. Considering that BD is a chronic disease with a typical onset in adolescence, the low rate of prescription of lithium salts in patients under 18 must be thoroughly studied.

Keywords: Adolescence onset; Adverse effects; Bipolar disorder; Dosing schedule; First episode; Lithium; Psychiatrists’ attitude; Survey.

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Conflict of interest statement

EV has received grants and served as consultant, advisor, or CME speaker unrelated to the present work for the following entities: AB-Biotics, Abbott, Allergan, Angelini, Dainippon Sumitomo Pharma, Ferrer, Gedeon Richter, Janssen, Lundbeck, Otsuka, Sage, Sanofi-Aventis, Sunovion, and Takeda. The other authors do not report any financial or other relationship relevant to the subject of this article.

Figures

Fig. 1
Fig. 1
Main reasons not to prescribe lithium
Fig. 2
Fig. 2
The preferred serum level and dose distribution of lithium
See this image and copyright information in PMC

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