Clinicians’ preferences and attitudes towards the use of lithium in the maintenance treatment of bipolar disorders around the world: a survey from the ISBD Lithium task force

Abstract

Background Lithium has long been considered the gold-standard pharmacological treatment for the maintenance treatment of bipolar disorders (BD) which is supported by a wide body of evidence. Prior research has shown a steady decline in lithium prescriptions during the last two decades. We aim to identify potential factors explaining this decline across the world with an anonymous worldwide survey developed by the International Society for Bipolar Disorders (ISBD) Task Force “Role of Lithium in Bipolar Disorders” and distributed by diverse academic and professional international channels. Results A total of 886 responses were received of which 606 completed the entire questionnaire while 206 completed it partially. Respondents were from 43 different countries comprising all continents. Lithium was the most preferred treatment option for the maintenance of BD patients (59%). The most relevant clinical circumstances in which lithium was the preferred option were in patients with BD I (53%), a family history of response (18%), and a prior response during acute treatment (17%). In contrast, Lithium was not the preferred option in case of patients´ negative beliefs and/or attitudes towards lithium (13%), acute side-effects or tolerability problems (10%) and intoxication risk (8%). Clinicians were less likely to prefer lithium as a first option in BD maintenance phase when practising in developing economy countries [X2 (1, N = 430) = 9465, p = 0.002) ] and private sectors [X2 (1, N = 434) = 8191, p = 0.004)]. Conclusions Clinicians’ preferences and attitudes towards the use of lithium in the maintenance treatment of bipolar disorders appear to be affected by both the patients’ beliefs and the professional contexts where clinicians provide their services. More research involving patients is needed for identifying their attitudes toward lithium and factors affecting its use, particularly in developing economies.

Lifetime risk of severe kidney disease in lithium-treated patients: a retrospective study

“…Lithium is perceived by a number of physicians and researchers as being underused (Zivanovic 2017 ), and this is a result of several factors: clinicians’ reluctance to initiate lithium treatment, treatment termination due to side effects (Öhlund et al 2018 ), but also patients’ refusal to accept lithium. A recent survey exploring clinicians' attitudes toward lithium use in bipolar disorders (Hidalgo-Mazzei et al 2023 ) reported that over 70% of respondents (886 clinicians in 43 countries) considered lithium as their first choice for maintenance medication in bipolar disorder. However, 55% of them expressed concerns about renal function alterations.…”

Why is lithium [not] the drug of choice for bipolar disorder? a controversy between science and clinical practice

“…Clinicians' preferences and attitudes towards the use of lithium in the maintenance treatment of bipolar disorders appear to be affected by both the patients' beliefs and the professional contexts where clinicians provide their services. In an international survey from the ISBD Lithium task force including 43 different countries comprising all continents lithium was the most preferred treatment option for the maintenance of bipolar disorder patients, although only preferred by 59% of clinicians (Hidalgo-Mazzei et al 2023 ). The low preference rate of 59% might be prompted in part by false beliefs about the availability of more modern, effective, and tolerable compounds such as second-generation antipsychotics which are also approved for the maintenance of bipolar disorder (Hidalgo-Mazzei et al 2023 ; Malhi et al 2020b ; Jauhar and Young 2019 ) and generally supported by a robust marketing.…”

“…In an international survey from the ISBD Lithium task force including 43 different countries comprising all continents lithium was the most preferred treatment option for the maintenance of bipolar disorder patients, although only preferred by 59% of clinicians (Hidalgo-Mazzei et al 2023 ). The low preference rate of 59% might be prompted in part by false beliefs about the availability of more modern, effective, and tolerable compounds such as second-generation antipsychotics which are also approved for the maintenance of bipolar disorder (Hidalgo-Mazzei et al 2023 ; Malhi et al 2020b ; Jauhar and Young 2019 ) and generally supported by a robust marketing. Clinicians were less likely to prefer lithium as a first option in bipolar disorder maintenance phase when practicing in developing economy countries (Hidalgo-Mazzei et al 2023 ).…”

“…The low preference rate of 59% might be prompted in part by false beliefs about the availability of more modern, effective, and tolerable compounds such as second-generation antipsychotics which are also approved for the maintenance of bipolar disorder (Hidalgo-Mazzei et al 2023 ; Malhi et al 2020b ; Jauhar and Young 2019 ) and generally supported by a robust marketing. Clinicians were less likely to prefer lithium as a first option in bipolar disorder maintenance phase when practicing in developing economy countries (Hidalgo-Mazzei et al 2023 ). In contrast, in a Spanish survey of psychiatrists belonging to the National Spanish Society of Biological Psychiatry, over 75% of the participants consider lithium salts the treatment of choice for the maintenance phase of bipolar disorder (Pérez de Mendiola et al 2021 ).…”

Lithium: how low can you go?

“…Despite this, lithium is widely reported to be under-used (relative to both the need for this medicine and its evidence base) (Post 2018 ). Reasons for this are varied, from education of both clinicians (Gomes et al 2022 ; Post 2018 ) and patients (Gomes et al 2022 ; Severus et al 2021 ) to associated negative beliefs and/or attitudes primarily relating to side effects or safety, again from both clinicians and patients (Hidalgo-Mazzei et al 2023 ). Further reasons include complexities or inconveniences related to the need for regular blood monitoring, which appears to be present from patient (McKeown et al 2022 ), clinician and service-level perspective (Nikolova et al 2018 ).…”