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Using Lithium in Older Age Bipolar Disorder: Special Considerations

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Abstract

Lithium is the gold-standard treatment for bipolar disorder, and is effective in the management of manic, depressive, and maintenance phases of bipolar disorder treatment. Despite this, the implications of lithium use in the older population remain less understood. This critical narrative review aims to better understand the impact of lithium in older age bipolar disorder (OABD), including tolerability and efficacy, based on up-to-date evidence. Relevant studies of efficacy, effectiveness, and tolerability published any time prior to May 2018 were identified using the PubMed keyword search “lithium older adult bipolar disorder” and references from recent international bipolar disorder guidelines. One randomized controlled trial was identified, the GERI-BD (Acute Pharmacotherapy in Late-Life Mania) study. This study found lithium to be effective in late-life mania and hypomania. The remaining literature examining lithium in OABD was reviewed, comprising of a number of small open-label and retrospective studies, with special considerations highlighted. In summary, there is a small yet increasing geriatric evidence base that lithium is effective in OABD. Although there can be adverse effects with lithium, it is generally well tolerated, and there are methods to minimize these risks. Further research would strengthen the evidence base for lithium therapy in OABD. In the meantime, lithium remains the gold-standard treatment for OABD.

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  1. Geri-PARTy Research Group, Department of Psychiatry, Jewish General Hospital, Institute of Community and Family Psychiatry, McGill University, 4333 Cote Ste-Catherine, Montreal, QC, H3T 1E4, Canada

    Jocelyn Fotso Soh, Sivan Klil-Drori & Soham Rej

  2. Department of Psychiatry, McGill University, Montreal, QC, Canada

    Soham Rej

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Jocelyn Fotso Soh, Sivan Klil-Drori, and Soham Rej have no conflicts of interest to declare. Soham Rej has received an investigator-initiated research grant from Satellite Healthcare for an unrelated project.

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Fotso Soh, J., Klil-Drori, S. & Rej, S. Using Lithium in Older Age Bipolar Disorder: Special Considerations. Drugs Aging 36, 147–154 (2019). https://doi.org/10.1007/s40266-018-0628-1

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