TY - JOUR

T1 - Starting lithium prophylaxis early v. late in bipolar disorder

AU - Kessing, Lars Vedel

AU - Vradi, Eleni

AU - Andersen, Per Kragh

N1 - Royal College of Psychiatrists.

PY - 2014/9

Y1 - 2014/9

N2 - BACKGROUND: No study has investigated when preventive treatment with lithium should be initiated in bipolar disorder.AIMS: To compare response rates among patients with bipolar disorder starting treatment with lithium early v. late.METHOD: Nationwide registers were used to identify all patients with a diagnosis of bipolar disorder in psychiatric hospital settings who were prescribed lithium during the period 1995-2012 in Denmark (n = 4714). Lithium responders were defined as patients who, following a stabilisation lithium start-up period of 6 months, continued lithium monotherapy without being admitted to hospital. Early v. late intervention was defined in two ways: (a) start of lithium following first contact; and (b) start of lithium following a diagnosis of a single manic/mixed episode.RESULTS: Regardless of the definition used, patients who started lithium early had significantly decreased rates of non-response to lithium compared with the rate for patients starting lithium later (adjusted analyses: first v. later contact: P<0.0001; hazard ratio (HR) = 0.87, 95% CI 0.76-0.91; single manic/mixed episode v. bipolar disorder: P<0.0001; HR = 0.75, 95% CI 0.67-0.84).CONCLUSIONS: Starting lithium treatment early following first psychiatric contact or a single manic/mixed episode is associated with increased probability of lithium response.

AB - BACKGROUND: No study has investigated when preventive treatment with lithium should be initiated in bipolar disorder.AIMS: To compare response rates among patients with bipolar disorder starting treatment with lithium early v. late.METHOD: Nationwide registers were used to identify all patients with a diagnosis of bipolar disorder in psychiatric hospital settings who were prescribed lithium during the period 1995-2012 in Denmark (n = 4714). Lithium responders were defined as patients who, following a stabilisation lithium start-up period of 6 months, continued lithium monotherapy without being admitted to hospital. Early v. late intervention was defined in two ways: (a) start of lithium following first contact; and (b) start of lithium following a diagnosis of a single manic/mixed episode.RESULTS: Regardless of the definition used, patients who started lithium early had significantly decreased rates of non-response to lithium compared with the rate for patients starting lithium later (adjusted analyses: first v. later contact: P<0.0001; hazard ratio (HR) = 0.87, 95% CI 0.76-0.91; single manic/mixed episode v. bipolar disorder: P<0.0001; HR = 0.75, 95% CI 0.67-0.84).CONCLUSIONS: Starting lithium treatment early following first psychiatric contact or a single manic/mixed episode is associated with increased probability of lithium response.

U2 - 10.1192/bjp.bp.113.142802

DO - 10.1192/bjp.bp.113.142802

M3 - Journal article

C2 - 25012681

VL - 205

SP - 214

EP - 220

JO - The Journal of mental science

JF - The Journal of mental science

SN - 0960-5371

IS - 3

ER -