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Clinicians’ preferences and attitudes towards the use of lithium in the maintenance treatment of bipolar disorders around the world: a survey from the ISBD Lithium task force
(2023-12-01)
Hidalgo-Mazzei, Diego
;
Mantingh, Tim
;
Pérez de Mendiola, Xavier
;
Samalin, Ludovic
;
UNDURRAGA FOURCADE, JUAN PABLO
Background: Lithium has long been considered the gold-standard pharmacological treatment for the maintenance treatment of bipolar disorders (BD) which is supported by a wide body of evidence. Prior research has shown a steady decline in lithium prescriptions during the last two decades. We aim to identify potential factors explaining this decline across the world with an anonymous worldwide survey developed by theInternational Society for Bipolar Disorders (ISBD) Task Force “Role of Lithium in Bipolar Disorders” anddistributed by diverse academic and professional international channels. Results: A total of 886 responses were received of which 606 completed the entirequestionnaire while 206 completed it partially. Respondents were from 43 different countries comprising allcontinents. Lithium was the most preferred treatment option for the maintenance of BD patients (59%). The mostrelevant clinical circumstances in which lithium was the preferred option were in patients with BD I (53%), afamily history of response (18%), and a prior response during acute treatment (17%). In contrast, Lithium wasnot the preferred option in case of patients´ negative beliefs and/or attitudes towards lithium (13%), acuteside-effects or tolerability problems (10%) and intoxication risk (8%). Clinicians were less likely to preferlithium as a first option in BD maintenance phase when practising in developing economy countries [X2 (1,N = 430) = 9465, p = 0.002)] and private sectors [X2 (1, N = 434) = 8191, p = 0.004)]. Conclusions: Clinicians’ preferences and attitudes towards the use of lithium in the maintenancetreatment of bipolar disorders appear to be affected by both the patients’ beliefs and the professionalcontexts where clinicians provide their services. More research involving patients is needed for identifyingtheir attitudes toward lithium and factors affecting its use, particularly in developing economies.
Scopus© Citations 28 1
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Efficacy and Tolerability of Combination Treatments for Major Depression: Antidepressants plus Second-Generation Antipsychotics vs. Esketamine vs. Lithium
(2021)
Gustavo H. Vázquez
;
Anees Bahji
;
UNDURRAGA FOURCADE, JUAN PABLO
;
Leonardo Tondo
;
Ross J. Baldessarini
<jats:sec><jats:title>Background:</jats:title><jats:p> Successful treatment of major depressive disorder (MDD) can be challenging, and failures ("treatment-resistant depression" [TRD]) are frequent. Steps to address TRD include increasing antidepressant dose, combining antidepressants, adding adjunctive agents, or using nonpharmacological treatments. Their relative efficacy and tolerability remain inadequately tested. In particular, the value and safety of increasingly employed second-generation antipsychotics (SGAs) and new esketamine, compared to lithium as antidepressant adjuncts remain unclear. </jats:p></jats:sec><jats:sec><jats:title>Methods:</jats:title><jats:p> We reviewed randomized, placebo-controlled trials and used random-effects meta-analysis to compare odds ratio (OR) versus placebo, as well as numbers-needed-to-treat (NNT) and to-harm (NNH), for adding SGAs, esketamine, or lithium to antidepressants for major depressive episodes. </jats:p></jats:sec><jats:sec><jats:title>Results:</jats:title><jats:p> Analyses involved 49 drug-placebo pairs. By NNT, SGAs were more effective than placebo (NNT = 11 [CI: 9–15]); esketamine (7 [5–10]) and lithium (5 [4–10]) were even more effective. Individually, aripiprazole, olanzapine+fluoxetine, risperidone, and ziprasidone all were more effective (all NNT < 10) than quetiapine (NNT = 13), brexpiprazole (16), or cariprazine (16), with overlapping NNT CIs. Risk of adverse effects, as NNH for most-frequently reported effects, among SGAs versus placebo was 5 [4–6] overall, and highest with quetiapine (NNH = 3), lowest with brexpiprazole (19), 5 (4–6) for esketamine, and 9 (5–106) with lithium. The risk/benefit ratio (NNH/NNT) was 1.80 (1.25–10.60) for lithium and much less favorable for esketamine (0.71 [0.60–0.80]) or SGAs (0.45 [0.17–0.77]). </jats:p></jats:sec><jats:sec><jats:title>Conclusions:</jats:title><jats:p> Several modern antipsychotics and esketamine appeared to be useful adjuncts to antidepressants for acute major depressive episodes, but lithium was somewhat more effective and better tolerated. </jats:p></jats:sec><jats:sec><jats:title>Limitations:</jats:title><jats:p> Most trials of adding lithium involved older, mainly tricyclic, antidepressants, and the dosing of adjunctive treatments were not optimized. </jats:p></jats:sec>
30Scopus© Citations 66
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Feasibility and cost minimisation for a lithium extraction problem
(2020)
BOSCH PÉREZ, PAUL JESÚS
;
J.P. Contreras
;
J. Munizaga-Rosas
10Scopus© Citations 5
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Lithium treatment for unipolar major depressive disorder: Systematic review
(2019)
Juan Undurraga
;
Kang Sim
;
Leonardo Tondo
;
Ariel Gorodischer
;
Emilio Azua
<jats:sec><jats:title>Background:</jats:title><jats:p> The potential value of lithium treatment in particular aspects of unipolar major depressive disorder remains uncertain. </jats:p></jats:sec><jats:sec><jats:title>Methods:</jats:title><jats:p> With reports of controlled trials identified by systematic searching of Medline, Cochrane Library, and PsycINFO literature databases, we summarized responses with lithium and controls followed by selective random-effects meta-analyses. </jats:p></jats:sec><jats:sec><jats:title>Results:</jats:title><jats:p> We identified 36 reports with 39 randomized controlled trials: six for monotherapy and 12 for adding lithium to antidepressants for acute major depression, and 21 for long-term treatment. Data for monotherapy of acute depression were few and inconclusive. As an adjunct to antidepressants, lithium was much more effective than placebo ( p<0.0001). For long-term maintenance treatment, lithium was more effective than placebo in monotherapy ( p=0.011) and to supplement antidepressants ( p=0.038), and indistinguishable from antidepressant monotherapy. </jats:p></jats:sec><jats:sec><jats:title>Conclusions:</jats:title><jats:p> The findings indicate efficacy of lithium as a treatment for some aspects of major depressive disorder, especially as an add-on to antidepressants and for long-term prophylaxis. It remains uncertain whether some benefits of lithium treatment occur with many major depressive disorder patients, or if efficacy is particular to a subgroup with bipolar disorder-like characteristics or mixed-features. </jats:p></jats:sec>
Scopus© Citations 64 8
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Impact of natural lithium ressources on suicide mortality in Chile 2000-2009: a geographical analysis
(2017)
Daniel König
;
Josef Baumgartner
;
Victor Blüml
;
ANDRES JURGEN HEERLEIN LOBENSTEIN
;
Carlos Téllez
27Scopus© Citations 16

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