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Lithium in late-life mania: a systematic review

Authors De Fazio P, Gaetano R, Caroleo M, Pavia M, De Sarro G, Fagiolini A, Segura-Garcia C

Received 4 November 2016

Accepted for publication 2 December 2016

Published 9 March 2017 Volume 2017:13 Pages 755—766


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 2

Editor who approved publication: Dr Roger Pinder

Pasquale De Fazio,1 Raffaele Gaetano,1 Mariarita Caroleo,1 Maria Pavia,2 Giovanbattista De Sarro,3 Andrea Fagiolini,4 Cristina Segura-Garcia1

1Department of Health Sciences, Psychiatric Unit, University Magna Græcia of Catanzaro, 2Department of Health Science, University Magna Græcia, 3Department of Health Sciences, Institute of Pharmacology, University Magna Græcia, Catanzaro, 4Department of Molecular Medicine, Division of Psychiatry, University of Siena, Siena, Italy

Abstract: The prevalence of mania among >65-year-olds ranges from 0.1% to 0.4% and its treatment is a particular challenge for clinicians. Although lithium is the treatment of choice for bipolar disorder (BD), its use in elderly population was recently questioned. This study provides a comprehensive review of literature on the efficacy and tolerability of lithium as a pharmacologic treatment for mania in elderly BD patients. We conducted a systematic review, based on PRISMA guidelines, of articles published between 1970 and August 2016 and indexed in the following databases: EMBASE, MEDLINE, Cochrane Library Databases and PsycINFO. The key words “age”, “late-life”, “geriatric”, “elderly”, and “older” were combined with words indicating pharmacologic treatments, such as lithium and other mood stabilizers and with the diagnostic terms “bipolar disorder” and “mania”. Fifteen out of 196 retrieved studies met our inclusion criteria. Seven studies evaluated both the efficacy and tolerability of lithium treatment in elderly BD patients; a further three evaluated only the efficacy and five assessed tolerability. Only limited data on the treatment of elderly BD patients are available, but evidence suggests that lithium is effective and tolerated in this subgroup of patients and thus should remain a first-line drug. It seems to be more effective at lower doses and close monitoring of plasma concentrations is necessary.

Keywords: bipolar disorder, lithium, elderly, late-life mania, efficacy, tolerability

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