Lithium Dispensing Patterns in Dutch Youth: Prevalence, Incidence Dosages, and Duration of Use From 2011 to 2022

OBJECTIVE: Bipolar disorder (BD) often emerges during mid-adolescence and young adulthood, and leads to functional and social impairment, with a prevalence of 0.87% among Dutch youth. Lithium, the first-line BD maintenance treatment, stabilizes mood, prevents suicide, and is well tolerated, yet its use has declined as long-term second-generation antipsychotics (SGAs) prescriptions increased. This study explores the prevalence, incidence, duration, prior and concurrent use of psychotropic medications, and dosage patterns of lithium dispensing in Dutch youth. METHOD: A retrospective cohort study using the Dutch community pharmacy-based IADB.nl database included 567 youths (6-25 years), who were dispensed lithium between 2011 and 2022. RESULTS: The yearly prevalence of lithium dispensing per 100,000 fluctuated between 30.3 in 2011 and 34.8 in 2022 (p = 0.40), with the lowest prevalence in 6-12-year-olds and highest in 20-25-year-olds. Females had overall higher prevalence rates than males (p = 0.03). Overall incidence rose from 7.9 to 9.3 (p = 0.68). In 2011, incidence was 10.7 for both the 13-19 and 20-25 age groups. By 2022, this decreased to 4.2 in 13-19-year-olds and increased to 19.0 in 20-25-year-olds. Approximately 55% of individuals received other psychotropics before lithium, and 52% concurrently, with SGAs and antidepressants being most commonly dispensed. CONCLUSION: Despite lithium's efficacy and status as first-line BD maintenance treatment, its dispensing in Dutch youth remains low compared to the BD prevalence. This may be due to misdiagnosis of BD and/or clinicians' reluctance to prescribe lithium, highlighting the need for improved diagnostics, clinician education, and further research into lithium's safety in youths.