Lithium prescribing trends: Review

Introduction: As evidence about the therapeutic efficacy of lithium increases paradoxically there is a decrease in lithium prescribing in actual clinical practice. This review investigates lithium prescribing trends and the reasons for them in some countries.
Methodology: We searched data in MEDLINE (PUBMED) - 1950 to August, 2010; PsycINFO – 1967 to August, 2010; and SCOPUS (EMBASE) – 1950 to August, 2010. After comprehensive electronic search, we found 6 studies related to trends in lithium prescribing trends.Out of the six studies, four reported declining and two rising lithium prescribing trends.
Results: Out of the four studies on declining trends, two were from US, one from Canada and one a study involving hospitals from Germany, Austria and Switzerland. Out of the two studies on rising trends, one was from Italy and the other from Spain. The various reasons for the declining trends were the unfavourable side effect profile of lithium, and the greater use of valproate, newer antipsychotics and combinations. The reasons for the increasing trends were – psycho-education for adherence, cultural factors, low cost of lithium and the greater availability of lithium.
Conclusion: The decline in lithium prescribing is not universal. Besides the efficacy of lithium in the treatment of bipolar mood disorders, various other reasons also play a role in lithium prescribing practices.