Time to lithium: A case register study of lithium initiation in bipolar disorder
Year: 2026
Type: article
Study design: Observational Study
Abstract: BACKGROUND: Lithium monotherapy has been recommended as first-line maintenance or long-term pharmacological therapy for bipolar disorder (BD). Previous research has linked early lithium use with better outcomes for people with BD. Despite extensive evidence as an effective treatment for BD, lithium prescribing continues to decline. AIMS: Our primary aim was to determine the time between initial assessment by mental health services and lithium initiation in people with BD who were prescribed and concordant with lithium. Secondary objectives included determining the time between the first assessment and recorded BD diagnosis, number of prior mood episodes, polarity when lithium was prescribed and number of antipsychotics before lithium initiation. METHODS: Free-text clinical notes were extracted from a de-identified electronic health record database. Eligible records comprised adults with a BD diagnosis who were concordant with lithium treatment. RESULTS: Eighty-eight people were identified, based on inclusion and exclusion criteria. Median time between first assessment and lithium initiation was 659 days. Median time between first assessment and BD diagnosis was 220 days, with a median of 2.5 mood episodes and 2 antipsychotics prescribed prior to lithium. Around 30% of people presented with manic symptoms at the time of lithium prescription. There is a significant delay between first contact with services and initiation of lithium in people with BD. CONCLUSIONS: This highlights the potential for earlier intervention with lithium, which could improve outcomes for people with BD.
Source: Journal of Psychopharmacology
Language: English
Subfield: Psychiatry and Mental health
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $4,400
Funders: Bristol-Myers Squibb, Eli Lilly and Company, Biogen, Teva Pharmaceutical Industries, Sunovion, National Alliance for Research on Schizophrenia and Depression, Wellcome Trust, National Institute for Health and Care Excellence, LivaNova, Mylan, Michael Smith Health Research BC, National Institute for Health and Care Research, Imperial College London, King's College London, Rosetrees Trust, Servier, H. Lundbeck A/S, Victoria General Hospital Foundation, NIHR Maudsley Biomedical Research Centre, Canadian Institutes of Health Research, Medical Research Council, National Institute of Mental Health
OpenAlex ID: W7128934452