Perspectives, attitude, and practice of lithium prescription among psychiatrists in India

Abstract

Introduction:Lithium “the magic pill” past its discovery remained the respite for patients with bipolar disorders for decades. The prescriptions of lithium were replaced by other drugs because of the cumbersome monitoring, adverse effect profile, narrow therapeutic index, and frequent comorbidities in patients. The objectives of this study were to understand the knowledge, attitude, and practice of lithium by a subset of psychiatrists in India, which will help us understand the theory–practice gap and for devising strategies to bridge the existing gap.Materials and Methods:The current study was an online survey which included 103 psychiatrists from India of either gender and any age group. Predesigned questionnaire about the knowledge, attitude, and practice of lithium use was circulated for 1 month (March 2018). We received 135 responses (31% response rate), of which 32 were incomplete. Hence, the total sample of psychiatrists included in the study was 103.Results:The results suggest that most practitioners included in the survey had knowledge about the effects, adverse effects, and the monitoring protocols and were comfortable in using lithium in patients on outpatient basis. Despite being aware of the indications, the psychiatrists were skeptical in starting lithium due to multitude of perceived barriers such as comorbidities, patient's low adherence to blood monitoring, and adverse effects.Conclusions:Clinicians should be well aware of the adverse effects, monitoring protocols, which will help them to use lithium in a more appropriate manner.

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

“…In general, our results indicating that clinicians use lithium in more than 50% of their BD patients as maintenance treatment are in line with previous reports and registries from diverse countries (Lin et al 2022 ; Mandal et al 2019 ; Pacciardi et al 2017 ; Pérez de Mendiola et al 2021 ; Sköld et al 2021 ). However, there is a striking diversity of prescriptions patterns among different countries (Kessing 2019b ), with some countries and regions having lithium prescription patterns below 50% (Grover et al 2021 ; Heeren et al 2011 ; Karanti et al 2016 ; Lyall et al 2019 ) or above (Bohlken et al 2020 ; Pérez de Mendiola et al 2021 ).…”

Lithium-Associated Hypothyroidism in a Specialized Lithium Clinic at a Tertiary Care Hospital in Riyadh, Saudi Arabia: A Retrospective Study

“…We hypothesize that this finding might reflect the psychiatrists' reluctance to prescribe lithium for patients who have hypothyroidism. This hypothesis is aligned with another study indicating that psychiatrists were skeptical about starting lithium due to several perceived barriers, among which are the adverse effects [26].…”

International Trends in Lithium Use for Pharmacotherapy and Clinical Correlates in Bipolar Disorder: A Scoping Review

“…Some reasons for this trend of decreased lithium use include its adverse effects and narrow therapeutic index [21], with a significant risk of toxicity at levels only 2-3 times above its therapeutic dose [22]. These concerns have been validated by physician opinion studies, which found low adherence to serum-level monitoring and side effects to be the most significant considerations that influenced lithium prescription in their practice [23,24]. There are also possible adverse effects on renal function and fetal growth, and its use in populations such as the elderly and pregnant women requires careful consideration of the risks and benefits [22].…”