Abstract
BackgroundLithium 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.MethodsData 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).Results212 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.ConclusionsFrom 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.
Highlights
Even though more than 70 years have passed since the Australian psychiatrist John Cade reported the antimanic efficacy of lithium carbonate (Cade 1949), the main current clinical guidelines still consider it a first-choicePérez de Mendiola et al Int J Bipolar Disord (2021) 9:10 allows preventing relapses or recurrences is vital
In addition to its mood-stabilizing properties, lithium has a distinctive, independent, and proven anti-suicide action (Barjasteh-Askari et al 2020; González-Pinto et al 2006; Smith and Cipriani 2017; Song et al, 2017). This is a relevant quality in bipolar disorder (BD) since up to 15% of patients diagnosed with BD die by suicide (Gordovez and McMahon 2020)
A systematic review and meta-analysis showed that treatment with lithium among people with mood disorders could reduce the risk of death and suicide up to 60% compared to placebo (Cipriani et al 2013)
Summary
Pérez de Mendiola et al Int J Bipolar Disord (2021) 9:10 allows preventing relapses or recurrences is vital In this regard, lithium continues to be the gold standard treatment supported by extensive scientific evidence (Carvalho et al, 2020). Remarkable neuroprotective and antiviral properties have been attributed to lithium (Post 2018; Rybakowski 2018; Murru et al 2020; Van Gestel et al 2019) It slows brain aging (Van Gestel et al 2019) and reduces the risk of dementia by almost 50% in patients with BD (Velosa et al 2020). 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
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