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Lithium Therapy in Old Age: Recommendations from a Delphi Survey
Julia Christl1, Bruno Müller-Oerlinghausen2,3, Michael Bauer4
1Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany.
Pharmacopsychiatry
|July 28, 2023
Summary
Lithium (Li) treatment for bipolar disorder in geriatric patients requires careful monitoring due to safety concerns. Experts developed 21 recommendations for Li initiation, monitoring, and withdrawal, but further research is needed for specific situations.
Area of Science:
- Geriatric Medicine
- Psychopharmacology
- Clinical Practice Guidelines
Background:
- Lithium (Li) is a standard treatment for bipolar disorder.
- Geriatric patients present unique challenges for Li therapy due to age-related physiological changes and polypharmacy.
- Limited research exists on Li management in elderly populations.
Purpose of the Study:
- To establish expert consensus on the safe and effective management of lithium therapy in geriatric patients.
- To address key aspects of Li treatment including initiation, monitoring, and withdrawal.
Main Methods:
- A Delphi survey was conducted with 24 German geriatric medicine and Li treatment experts.
- Two rounds of questionnaires were followed by a final consensus formulation.
- Recommendations required at least 80% expert agreement.
Main Results:
- Consensus was reached on 21 clinical recommendations covering laboratory checks, concomitant medications, and target Li serum concentrations.
- Agreed-upon guidelines exist for Li therapy termination, including tapering duration and alternatives.
- No consensus was achieved on using Li in patients with dementia or frailty, or on specific renal function thresholds for withdrawal.
Conclusions:
- German experts support the use of lithium in geriatric patients under careful monitoring.
- The identified areas of non-consensus highlight the need for further research into specific Li treatment scenarios in the elderly.
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