title: Lithium in bipolar and other affective disorders: prescribing practice in the UK.
abstract: 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.
authors.affiliation: Centre for Mental Health, Imperial College Faculty of Medicine, Charing Cross Campus, St Dunstan’s Road, London, UK. Carol.Paton@oxleas.nhs.uk
authors.forename: Carol
authors.initials: C
authors.lastname: Paton
authors.forename: Thomas R E
authors.initials: TR
authors.lastname: Barnes
authors.forename: Amber
authors.initials: A
authors.lastname: Shingleton-Smith
authors.forename: R Hamish
authors.initials: RH
authors.lastname: McAllister-Williams
authors.forename: James
authors.initials: J
authors.lastname: Kirkbride
authors.forename: Peter B
authors.initials: PB
authors.lastname: Jones
authors.forename: Samantha
authors.initials: S
authors.lastname: McIntyre
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018692:Antimanic Agents / Q000493:pharmacokinetics / Q000627:therapeutic use*; D001714:Bipolar Disorder / Q000188:drug therapy*; D016903:Drug Monitoring / Q000379:methods; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D018020:Lithium Compounds / Q000493:pharmacokinetics / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D019964:Mood Disorders / Q000188:drug therapy; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D006113:United Kingdom; D055815:Young Adult
chemical_list: D018692:Antimanic Agents; D018020:Lithium Compounds