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Use of Lithium in the Treatment of Bipolar Disorder in Late-Life

  • Bipolar Disorders (David S. Janowsky, Section Editor)
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Abstract

Lithium is the oldest and still one of the most frequently prescribed mood stabilizers in the treatment of bipolar disorder. Nonetheless, the evidence for lithium efficacy in older patients with bipolar disorder is almost entirely extrapolated from younger adult patients. Here we review the literature on lithium in older patients with bipolar disorder, concentrating on the past 3 years. A definitive study demonstrating the efficacy and safety of lithium in older patients with bipolar disorder is still missing. However, several lines of indirect evidence suggest that it is beneficial and advantageous over other mood stabilizers in the acute and maintenance treatment of late-life bipolar disorder. In addition, lithium may have unique properties as a regenerative therapeutic with specific benefits in reducing the cognitive impairment and suicide rates associated with bipolar disorder across the adult lifespan. Aging-associated pharmacokinetic and pharmacodynamic changes as well as increased rates of medical comorbidities and polypharmacy predispose older patients to a higher risk of lithium toxicity. Careful monitoring and adjustment of lithium dosage is especially important in older adults to minimize the risk of toxicity.

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Disclosure

Dr. Rajji has received grant support from the National Institute of Mental Health and the Canadian Institutes of Health Research.

Dr. Mulsant has served on boards for the Center for Addiction and Mental Health and the Center for Addiction and Mental Health Foundation; has received grant support from the National Institutes of Health and Canadian Institutes of Health Research; has received donations of medication for use in National Institutes of Health–funded clinical trials from Bristol-Myers Squibb, Pfizer, and Wyeth; and previously held stock in Akzo Nobel, Alkermes, AstraZeneca, Biogen Idec, Celsion Corp., Elan Corp., Eli Lilly and Company, Forest Laboratories, Orchestra Therapeutics, and Pfizer.

Dr. Pollock has served on an advisory board for Lundbeck Canada, served as a consultant for Wyeth, received grant support from the National Institutes of Health and the Canadian Institutes of Health Research, and has had travel and accommodation expenses covered for trips to annual meetings by the Lundbeck International Neuroscience Foundation (for which he was previously a faculty member).

Ramsey D’Souza reported no potential conflicts of interest relevant to this article.

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Authors and Affiliations

  1. Division of Geriatric Psychiatry, University of Toronto, and Geriatric Mental Health Program, Centre for Addiction and Mental Health, 1001 Queen Street West, Toronto, Ontario, M6J 1H4, Canada

    Ramsey D’Souza & Tarek K. Rajji

  2. Division of Geriatric Psychiatry, University of Toronto, and Geriatric Mental Health Program, Centre for Addiction and Mental Health, 901 King Street West, Toronto, Ontario, M6J 1H4, Canada

    Benoit H. Mulsant

  3. Division of Geriatric Psychiatry, University of Toronto, and Geriatric Mental Health Program, Centre for Addiction and Mental Health, 33 Russell Street, Toronto, Ontario, M5S 2S1, Canada

    Bruce G. Pollock

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  1. Ramsey D’Souza
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  2. Tarek K. Rajji
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  3. Benoit H. Mulsant
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  4. Bruce G. Pollock
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Correspondence to Tarek K. Rajji.

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D’Souza, R., Rajji, T.K., Mulsant, B.H. et al. Use of Lithium in the Treatment of Bipolar Disorder in Late-Life. Curr Psychiatry Rep 13, 488–492 (2011). https://doi.org/10.1007/s11920-011-0228-9

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