For instance, lithium associated weight gain could be secondary to hypothyroidism. 2015;13:12. Lithium is a mainstay in treating bipolar disorder, especially for acute mania and bipolar maintenance therapy. Psychiatric reasons were given in 44% and physical health reasons in 12% of all episodes (p < 0.001) (Table 2). Norgine (who used to manufacture Camcolit) and Delandale (who used to manufacture Priadel) have disputed which had the superior sustained release, but careful analysis of their presented data comparing the 400mg tablets showed the differences to be insignificant. This is in line with findings of three of the previous studies, which also found that adverse event was the most common reason for lithium discontinuation [11,12,13]. Understanding the reasons why patients and doctors discontinue lithium can assist us to develop strategies to improve adherence. 2004;3:56–64. Clin Approach Bipolar Disord. In the 1960s manic-depressive psychosis was divided into unipolar depression (patients with mainly depression), unipolar mania (patients with mainly mania) and bipolar disorder (patients with both depression and mania). The British National Formulary carries a warning that “different versions of modified-release preparations may not have the same clinical effect … [so] prescribers should specify the brand to be dispensed”. 4. Higher-risk lithium patients include: The LiSERS (Lithium Side Effect Rating Scale)[9] should be used to monitor the transition, and lithium levels should be arranged no later than three months after the switch. This has now mainly been superseded by division into bipolar disorder types I and II. The consent was documented in our research files, dated and signed by the research worker who obtained the consent. Creatinine increases accounted for three times as many episodes of lithium discontinuation in patients with type 1 BPAD or SZD (p < 0.001). We wish to thank Amanda Keinström Sihvonen, Sofia Månsson and Nazanin Shayeghi for their help with the validation of the clinical information, and Annika Essner, Anna Granberg, Annika Johansson, Ulrika Lundmark, Anna Nyberg, Eva Lång Rhyn for their help with assistance in conduct of the study. Lithium is a naturally occurring element that is used to treat mania in cases of bipolar disorder. We used this information to quantify overall reasons for lithium discontinuation. Yet, sugar-sweetened drinks, such as soft drinks and juices, are a major contributor to obesity world-wide [26]. It is likely that some people will find the change unsettling; however, most patients can be switched in primary care, with secondary care services providing guidance, support and training as required. Men and women were equally likely to discontinue lithium. Men had twice as often discontinued lithium without consulting a doctor (p < 0.01). Retrospective cohort study in the Swedish region of Norrbotten into the causes of lithium discontinuation. Pakpour AH, Modabbernia A, Lin C, Saffari M, Asl MA, Webb T. Promoting medication adherence among patients with bipolar disorder: a multicenter randomized controlled trial of a multifaceted intervention. & Schou , M. ( 1980 ) Clinically significant side-effects of lithium treatment: a survey of 237 patients on long-term medication. Ever since publication of the BALANCE trial in 2010 [1], lithium has experienced a renaissance as maintenance treatment for bipolar affective disorder (BPAD) in Europe. The second category related to physical health reasons that could interfere with lithium. [National Patient … There were thirteen patients who took lithium for at least two years before finally stopping due to diarrhoea. Others complain of side effects and avoid their medication altogether. Here, we excluded patients for whom such prior episodes of lithium discontinuation were found or where information was missing. Less Common:Acne or skin rash; bloated feeling or pressure in the stomach; muscle twitching (slight) Notify your doctor as soon as possible if you experience any of the following side effects of lithium: 1. 1970;116:615–9. JAMA Psychiat. Psychiatric reasons were given in 44% of all episodes. Maarbjerg K, Aagaard J, Vestergaard P. Adherence to lithium prophylaxis: I. First, we summarize the evidence on efficacy in general, from relapse … We divided reasons for lithium discontinuation into three main categories. Ursula Werneke has received funding for educational activities on behalf of Norrbotten Region (Masterclass Psychiatry Programme, EAPM 2016 Luleå, Sweden): Astra Zeneca, Janssen, Eli Lilly, Novartis, Otsuka/Lundbeck, Servier, Sunivion and Shire. The five single most common adverse effects leading to lithium discontinuation included diarrhoea (13%), tremor (11%), polyuria/polydipsia/diabetes insipidus (9%), creatinine increase (9%) and weight gain (7%). All reasons for lithium were assessed by two separate reviewers to minimize observer bias. 1999;89:247–57. I take Lithium and Latuda - and I have to wonder if it's not the Lithium. Mortality gap for people with bipolar disorder and schizophrenia: UK-based cohort study 2000-2014. BMC Psychiatry. The structure of the data set and the coding specification are available from the authors. In 2014, the UK National Institute for Clinical Excellence (NICE) endorsed lithium as a first-line, long-term pharmacological treatment for bipolar disorder [2]. Age and sex were not significantly different in patients included and excluded from this sub-analysis. 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