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      Clinical use of lithium salts: guide for users and prescribers

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          Abstract

          Background

          Lithium has been used clinically for 70 years, mainly to treat bipolar disorder. Competing treatments and exaggerated impressions about complexity and risks of lithium treatment have led to its declining use in some countries, encouraging this update about its safe clinical use. We conducted a nonsystematic review of recent research reports and developed consensus among international experts on the use of lithium to treat major mood disorders, aiming for a simple but authoritative guide for patients and prescribers.

          Main text

          We summarized recommendations concerning safe clinical use of lithium salts to treat major mood disorders, including indications, dosing, clinical monitoring, adverse effects and use in specific circumstances including during pregnancy and for the elderly.

          Conclusions

          Lithium continues as the standard and most extensively evaluated treatment for bipolar disorder, especially for long-term prophylaxis.

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          Most cited references87

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          Suicide as an outcome for mental disorders. A meta-analysis.

          Erica Harris, Peter B. Barraclough, Christopher C. Harris (1997)
          Mental disorders have a strong association with suicide. This meta-analysis, or statistical overview, of the literature gives an estimate of the suicide risk of the common mental disorders. We searched the medical literature to find reports on the mortality of mental disorders. English language reports were located on MEDLINE (1966-1993) with the search terms mental disorders', 'brain injury', 'eating disorders', 'epilepsy', 'suicide attempt', 'psychosurgery', with 'mortality' and 'follow-up studies', and from the reference lists of these reports. We abstracted 249 reports with two years or more follow-up and less than 10% loss of subjects, and compared observed numbers of suicides with those expected. A standardised mortality ratio (SMR) was calculated for each disorder. Of 44 disorders considered, 36 have a significantly raised SMR for suicide, five have a raised SMR which fails to reach significance, one SMR is not raised and for two entries the SMR could not be calculated. If these results can be generalised then virtually all mental disorders have an increased risk of suicide excepting mental retardation and dementia. The suicide risk is highest for functional and lowest for organic disorders with substance misuse disorders lying between. However, within these broad groupings the suicide risk varies widely.
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            The International Society for Bipolar Disorders (ISBD) task force report on antidepressant use in bipolar disorders.

            Aysegul Ozerdem, Jean-Michel Azorin, Ross J Baldessarini … (2013)
            The risk-benefit profile of antidepressant medications in bipolar disorder is controversial. When conclusive evidence is lacking, expert consensus can guide treatment decisions. The International Society for Bipolar Disorders (ISBD) convened a task force to seek consensus recommendations on the use of antidepressants in bipolar disorders. An expert task force iteratively developed consensus through serial consensus-based revisions using the Delphi method. Initial survey items were based on systematic review of the literature. Subsequent surveys included new or reworded items and items that needed to be rerated. This process resulted in the final ISBD Task Force clinical recommendations on antidepressant use in bipolar disorder. There is striking incongruity between the wide use of and the weak evidence base for the efficacy and safety of antidepressant drugs in bipolar disorder. Few well-designed, long-term trials of prophylactic benefits have been conducted, and there is insufficient evidence for treatment benefits with antidepressants combined with mood stabilizers. A major concern is the risk for mood switch to hypomania, mania, and mixed states. Integrating the evidence and the experience of the task force members, a consensus was reached on 12 statements on the use of antidepressants in bipolar disorder. Because of limited data, the task force could not make broad statements endorsing antidepressant use but acknowledged that individual bipolar patients may benefit from antidepressants. Regarding safety, serotonin reuptake inhibitors and bupropion may have lower rates of manic switch than tricyclic and tetracyclic antidepressants and norepinephrine-serotonin reuptake inhibitors. The frequency and severity of antidepressant-associated mood elevations appear to be greater in bipolar I than bipolar II disorder. Hence, in bipolar I patients antidepressants should be prescribed only as an adjunct to mood-stabilizing medications.
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              Lithium salts in the treatment of psychotic excitement.

              Richard Cade (1949)
              Article 0 comments Cited 132 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                Leonardo Tondo:
                ORCID: http://orcid.org/0000-0002-1624-0522
                +39-070-486624 , ltondo@aol.com
                Journal
                Journal ID (nlm-ta): Int J Bipolar Disord
                Journal ID (iso-abbrev): Int J Bipolar Disord
                Title: International Journal of Bipolar Disorders
                Publisher: Springer Berlin Heidelberg (Berlin/Heidelberg )
                ISSN (Electronic): 2194-7511
                Publication date (Electronic): 22 July 2019
                Publication date PMC-release: 22 July 2019
                Publication date Collection: 2019
                Volume: 7
                Electronic Location Identifier: 16
                Affiliations
                [1 ]ISNI 0000 0000 8795 072X, GRID grid.240206.2, International Consortium for Research on Mood & Psychotic Disorders, , McLean Hospital, ; Belmont, MA USA
                [2 ]ISNI 000000041936754X, GRID grid.38142.3c, Department of Psychiatry, , Harvard Medical School, ; Boston, MA USA
                [3 ]Lucio Bini Mood Disorders Centers, Lucio Bini Center, Via Cavalcanti 28, 09128 Cagliari and Rome, Italy
                [4 ]ISNI 0000 0004 1936 8200, GRID grid.55602.34, Department of Psychiatry, , Dalhousie University, ; Halifax, NS Canada
                [5 ]ISNI 0000 0001 1091 2917, GRID grid.412282.f, Department of Psychiatry and Psychotherapy, , Carl Gustav Carus University Hospital Dresden, ; Dresden, Germany
                [6 ]ISNI 0000 0001 0670 2351, GRID grid.59734.3c, Department of Psychiatry and Department of Obstetrics, Gynecology and Reproductive Science, , Icahn School of Medicine at Mount Sinai, ; New York, USA
                [7 ]ISNI 000000040459992X, GRID grid.5645.2, Department of Psychiatry, , Erasmus Medical Center, ; Rotterdam, The Netherlands
                [8 ]ISNI 0000 0001 2157 2938, GRID grid.17063.33, Mood Disorders Center of Ottawa and Department of Psychiatry, , University of Toronto, ; Toronto, Canada
                [9 ]ISNI 0000 0001 0742 471X, GRID grid.5117.2, Department of Clinical Medicine, , Aalborg University, ; Aalborg, Denmark
                [10 ]ISNI 0000 0001 0742 471X, GRID grid.5117.2, Aalborg University Hospital–Psychiatry, ; Aalborg, Denmark
                [11 ]ISNI 0000 0004 1936 8200, GRID grid.55602.34, Department of Pharmacology, , Dalhousie University, ; Halifax, NS Canada
                [12 ]ISNI 0000 0004 1755 3242, GRID grid.7763.5, Section of Psychiatry, Department of Medical Sciences and Public Health, , University of Cagliari, ; Cagliari, Italy
                [13 ]ISNI 0000 0001 1086 8477, GRID grid.489522.0, Drug Commission of the German Medical Association, ; Berlin, Germany
                [14 ]International Advocacy, New York, USA
                [15 ]Medical Faculty, Bipolar Center, Sigmund Freud Private University, Wiener Neustadt, Austria
                Author information
                http://orcid.org/0000-0002-1624-0522
                Article
                Publisher ID: 151
                DOI: 10.1186/s40345-019-0151-2
                PMC ID: 6643006
                PubMed ID: 31328245
                SO-VID: 9b905f4e-b0ff-4120-90c3-f674c204b9e4
                Copyright © © The Author(s) 2019
                License:

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

                History
                Date received : 14 May 2019
                Date accepted : 27 June 2019
                Funding
                Funded by: Bruce Anderson
                Award ID: 123456
                Award Recipient :
                Categories
                Subject: Review
                Custom metadata
                issue-copyright-statement © The Author(s) 2019

                Keywords: bipolar disorder,blood testing,dosing,lithium,side-effects
                Data availability:
                Keywords: bipolar disorder, blood testing, dosing, lithium, side-effects

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