Lithium: The Forgotten Wonderdrug

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Trends in Treatment of Bipolar Disorder by Outpatient Psychiatrists • Sample from the National Ambulatory Medical Care Survey between 1992 and 1999 – 1992 to 1995 more than half of visits for bipolar disorder included a prescription for lithium – 1996 to 1999 only 30% included a prescription of lithium Blanco C, Laje G, Olfson M, Marcus SC, Pincus HA. Trends in the treatment of bipolar disorder by outpatient psychiatrists. Am J Psychiatry. 2002 Jun;159(6):1005-10.
Trend in Veterans Affairs Medical Center in Palo Alto, CA • Between 1989 and 1994 for patients with bipolar disorder – <strong>Lithium</strong> monotherapy declined from 84% to 43% – <strong>Lithium</strong> in combination with divalproex increased from 0 to 25% Fenn HH, Robinson D, Luby V, Dangel C, Buxton E, Beattie M, Kraemer H, Yesavage JA. Trends in pharmacotherapy of Schizoaffective and bipolar affective disorders: a 5-year naturalistic study. Am J Psychiatry. 1996 May;153(5):711-3.
Page 1 and 2: Lithium: The Forgotten Wonderdrug W
Page 3: What Is Lithium
Page 7 and 8: History • 1880s to early 1900s li
Page 9 and 10: Psychiatric Uses For Lithium • An
Page 11 and 12: Advantages of Lithium • Well esta
Page 13: Decline In Lithium Use
Page 17 and 18: Lithium Therapy And Suicide Risk In
Page 19 and 20: Suicide Risk in Mood Disorders •
Page 21 and 22: Overall Rates • Suicides and atte
Page 23 and 24: Rates of Suicide Attempts • Suici
Page 25 and 26: Risk Reduction in Diagnostic Subtyp
Page 27 and 28: Other Important Risk Factors in Sui
Page 29 and 30: Limitations of Evidence • Lack of
Page 31 and 32: Rationale For Long Term Treatment W
Page 33 and 34: Relapse in Bipolar Disorder • Des
Page 35 and 36: Episode Recurrence in Bipolar I Dis
Page 37 and 38: Episode Recurrence in Bipolar I Dis
Page 39 and 40: Reduction of Episode Recurrence •
Page 41 and 42: Risk vs Benefit Of Lithium Maintena
Page 43 and 44: Potential Toxicity of Long Term Lit
Page 45 and 46: Reducing Risk, Increasing Benefit:
Page 47 and 48: Initiating and Monitoring Lithium T
Page 49 and 50: Initiating Lithium • Prior to ini
Page 51 and 52: Blood Monitoring • Lithium can be
Page 53 and 54: Therapeutic Levels • Upper end: 1
Page 55 and 56: Lithium Discontinuation
Page 57 and 58: Reduced Morbidity After Gradual Dis
Page 59 and 60: Lithium Discontinuation and Subsequ
Page 61 and 62: APA Treatment Guidelines For Bipola
Page 63 and 64: Bipolar Depression • First line t
Page 65 and 66:
Maintenance “The medications with
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Lithium: The Forgotten Wonderdrug

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