Öhlund L, et al. - Despite lithium’s proven benefits concerning the prevention of severe affective episodes and suicide, about half of all individuals with bipolar disorder could stop their treatment at some point. Researchers, in this retrospective cohort study, searched for reasons for lithium discontinuation among these individuals. They observed that stopping lithium treatment was common and occurred mostly due to adverse effects. The frequency of potentially unnecessary discontinuations could be reduced with discussing potential adverse effects with patients before initiation and continuously during lithium treatment.

Methods

• Researchers performed a retrospective cohort study in the Swedish region of Norrbotten to examine the causes of lithium discontinuation.
• In this study, they sought to
• Test whether patients with bipolar affective disorder or schizoaffective disorder, treated with lithium maintenance therapy, were more likely to discontinue lithium because of adverse effects than lack of therapeutic effectiveness,
• Explore gender differences,
• Understand the role of diagnosis and
• Identify who, patient or doctor, took the initiative to stop lithium.
• They performed review of medical records for all episodes of lithium discontinuation that had occurred between 1997 and 2013 with the intent to stop lithium for good.

Results

• A total 873 patients were recognized who received lithium treatment; of these, 54% discontinued lithium, corresponding to 561 episodes of lithium discontinuation.
• Lithium was discontinued in 62% of episodes due to adverse effects, in 44% due to psychiatric reasons, and in 12% due to physical reasons interfering with lithium treatment.
• Diarrhoea (13%), tremor (11%), polyuria/polydipsia/diabetes insipidus (9%), creatinine increase (9%) and weight gain (7%) were the five single most common adverse effects resulting in lithium discontinuation.
• Researchers noticed that women and men were similar in taking the initiative to stop lithium, but women were twice as likely to consult a doctor before taking action (p < 0.01).
• Patients with type 1 BPAD or SZD had higher tendency for discontinuing lithium than patients with type 2 or unspecified BPAD (p < 0.01).
• Patients with type 1 BPAD or SZD more frequently refused medication (p < 0.01).
• Conversely, for lack or perceived lack of effectiveness, patients with type 2 or unspecified BPAD were 3 times as likely to discontinue lithium (p < 0.001).