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

Lookup NU author(s): Professor Hamish McAllister-WilliamsORCiD


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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.

Publication metadata

Author(s): Paton C, Barnes TRE, Shingleton-Smith A, McAllister-Williams RH, Kirkbride J, Jones PB, McIntyre S

Publication type: Article

Publication status: Published

Journal: Journal of Psychopharmacology

Year: 2010

Volume: 24

Issue: 12

Pages: 1739-1746

Print publication date: 20/05/2010

ISSN (print): 0269-8811

ISSN (electronic): 1461-7285

Publisher: Sage Publications Ltd.


DOI: 10.1177/0269881110367728


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