Time to lithium: a case register study of lithium initiation in bipolar disorder

Background: Lithium monotherapy has been recommended as first-line maintenance or long term pharmacological therapy for bipolar disorder (BD). Previous research has linked early lithium use with better outcomes for people with BD. Despite extensive evidence as an effective treatment for BD, lithium prescribing continues to decline. Aims: Our primary aim was to determine time between initial assessment by mental health services and lithium initiation in people with BD who initiated lithium. Secondary objectives included determining time between first assessment and recorded BD diagnosis, number of prior mood episodes, polarity when lithium was prescribed and number of antipsychotics before lithium initiation. Methods: Free-text clinical notes were extracted from a de-identified electronic health record database. Eligible records comprised adults with BD diagnosis who were concordant with lithium treatment. Results: 88 people were identified, based on inclusion and exclusion criteria. Median time between first assessment and lithium initiation was 659 days. Median time between first assessment and BD diagnosis was 220 days, with a median of 2.5 mood episodes and 2 antipsychotics prescribed prior to lithium. Around 30% of people presented with manic symptoms at time of lithium prescription. There is significant delay between first contact with services and initiation of lithium in people with BD. Conclusions: This highlights the potential for earlier intervention with lithium, which could improve of outcomes for people with BD.