Lithium in bipolar and other affective disorders: prescribing practice in the UK

Abstract

The use of lithium for the treatment of mania, prophylaxis of bipolar disorder and augmentation of antidepressants in treatment-refractory unipolar depression is supported by British Association for Psychopharmacology and National Institute for Health and Clinical Excellence guidelines. We describe prescribing patterns with lithium in a large sample of patients with affective disorders. Data were collected during a baseline clinical audit of the quality of lithium monitoring, conducted by the Prescribing Observatory for Mental Health. Thirty-five National Health Service Trusts submitted data for 2776 patients with a diagnosis of affective illness (ICD10 F30-39), 1919 (69%) of whom had bipolar affective disorder. The last recorded lithium level was below the therapeutic range (<0.4 mmol/L) in one in 10 patients. Co-prescribing was common; 57% of bipolar patients were prescribed an antipsychotic and 77% of those with other affective disorders, an antidepressant. We conclude that serum lithium levels within the therapeutic range are maintained in the majority of patients. A high proportion of patients are co-prescribed other psychotropic drugs; such prescribing is consistent with evidence-based treatment guidelines and may reflect difficulty managing the symptoms of affective disorders with lithium monotherapy. A significant minority of patients prescribed lithium had a sub-therapeutic blood level and so may be at high risk of relapse.

Efficacy of pharmacotherapy in bipolar disorder: a report by the WPA section on pharmacopsychiatry

“…The Prescribing Observatory for Mental Health reviewed data from 35 National Health Service Trusts on 2,776 patients with a diagnosis of affective illness. These data suggested that 10 % of patients had lithium levels below the therapeutic range and that co-prescribing lithium plus antipsychotics was common (57 %) [381].…”

Use of Lithium in the Treatment of Bipolar Disorder in Late-Life

“…In addition, this study confirmed that older patients require lower doses of lithium than younger ones to reach therapeutic levels. In contrast, the therapeutic threshold was comparable between old and young patients, as older patients with a lithium level below 0.4 mmol/L were more likely to relapse than those with a higher level [18].…”

“…A large retrospective study that included about 2,000 participants in the United Kingdom found that lithium was prescribed less often to older patients than to younger patients with bipolar disorder [18]. More than 80% of patients were also prescribed another psychotropic medication.…”

In situ cellular level Raman spectroscopy of the thyroid

“…Lithium drugs treatment is a chronic treatment that reduces suicide risk and prevents manic and depressive episodes [19,20]. The exact mechanisms for how lithium acts on the brain are presently not fully understood.…”