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

Abstract

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.