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Lithium in late-life mania: a systematic review
Pasquale De Fazio1, Raffaele Gaetano1, Mariarita Caroleo1
1Department of Health Sciences, Psychiatric Unit, University Magna Græcia of Catanzaro.
Neuropsychiatric Disease and Treatment
|March 24, 2017
Summary
Lithium remains an effective and well-tolerated treatment for mania in elderly bipolar disorder (BD) patients. Evidence supports its use as a first-line pharmacologic option in older adults, with careful monitoring.
Area of Science:
- Geriatric Psychiatry
- Pharmacology
- Bipolar Disorder Research
Background:
- Mania affects 0.1% to 0.4% of individuals over 65.
- Treating mania in the elderly presents unique clinical challenges.
- The use of lithium, a standard treatment for bipolar disorder (BD), in older populations has been questioned.
Purpose of the Study:
- To conduct a comprehensive literature review on lithium's efficacy and tolerability for mania in elderly BD patients.
- To evaluate current evidence regarding lithium as a pharmacologic treatment for geriatric mania.
Main Methods:
- Systematic review adhering to PRISMA guidelines.
- Searched EMBASE, MEDLINE, Cochrane Library, and PsycINFO databases (1970-August 2016).
- Keywords included age-related terms, lithium, mood stabilizers, bipolar disorder, and mania; 15 studies met inclusion criteria.
Main Results:
- Limited data exist, but suggest lithium is effective for mania in elderly BD patients.
- Lithium demonstrated good tolerability in this population.
- Evidence indicates lithium may be more effective at lower doses, necessitating close plasma concentration monitoring.
Conclusions:
- Lithium should remain a first-line pharmacologic treatment for mania in elderly patients with bipolar disorder.
- Continued research is needed to further elucidate optimal dosing and monitoring strategies for this demographic.
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