Current opinion in psychiatry · 2026
An international initiative to implement recommendations for a lower therapeutic range of maintenance lithium in older adults with bipolar disorder.
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Shulman Kenneth I, Nunes Paula V, Fu Lei, Eyler Lisa T
Аннотация
PURPOSE OF REVIEW: The aim of this study was to promote the universal recommendation that lithium carbonate remains the first-choice mood stabilizer for maintenance treatment of older adults with bipolar disorder (OABD) as concluded in a Delphi survey of the International Society for Bipolar Disorders (ISBD) as well as all other official guidelines.
RECENT FINDINGS: Prescriptions of lithium have continued to decline in OABD worldwide despite these recommendations and in the face of evidence for its effectiveness as a mood stabilizer and lithium's potential for suicide prevention and neuroprotection from dementia. This study describes the results of a recent literature review of the role of lithium in OABD, finding further support from the recommended therapeutic range of 0.4-0.8 mmol/l for those aged 60-79 years and 0.4-0.7 mmol/l for those 80 and over, and summarizing prescribing considerations. We also provide evidence of the practicality of measuring and reporting age-specific ranges from a laboratory medicine perspective. Finally, we report on an international initiative of the ISBD OABD task force that aims to implement the lower recommended therapeutic ranges for maintenance lithium treatment as reported by laboratories around the world.
SUMMARY: Initial efforts in Canada have resulted in the implementation of widespread changes in laboratory reporting. International efforts to implement separate and lower therapeutic ranges for lithium in OABD are continuing; so far, 18 dissemination attempts have yielded three successful implementations. This initiative aims to provide well tolerated and effective lithium treatment for OABD while reducing the risk of toxicity in this vulnerable group of patients.
RECENT FINDINGS: Prescriptions of lithium have continued to decline in OABD worldwide despite these recommendations and in the face of evidence for its effectiveness as a mood stabilizer and lithium's potential for suicide prevention and neuroprotection from dementia. This study describes the results of a recent literature review of the role of lithium in OABD, finding further support from the recommended therapeutic range of 0.4-0.8 mmol/l for those aged 60-79 years and 0.4-0.7 mmol/l for those 80 and over, and summarizing prescribing considerations. We also provide evidence of the practicality of measuring and reporting age-specific ranges from a laboratory medicine perspective. Finally, we report on an international initiative of the ISBD OABD task force that aims to implement the lower recommended therapeutic ranges for maintenance lithium treatment as reported by laboratories around the world.
SUMMARY: Initial efforts in Canada have resulted in the implementation of widespread changes in laboratory reporting. International efforts to implement separate and lower therapeutic ranges for lithium in OABD are continuing; so far, 18 dissemination attempts have yielded three successful implementations. This initiative aims to provide well tolerated and effective lithium treatment for OABD while reducing the risk of toxicity in this vulnerable group of patients.