Lithium in Older Age Bipolar Disorder

TL;DR: An overview of the epidemiology of these effects with an emphasis on geriatric data and potential mechanisms underlying these medical effects is provided, as well as guidance on lithium dosing and other strategies to minimize lithium-associated medical effects in older age bipolar disorder.

Abstract: Lithium remains the gold-standard medication for bipolar disorder, with 30–40 % of older patients responding preferentially to its use. However, its use is limited by potential medical adverse effects. Medical effects include renal disease (nephrogenic diabetes insipidus, acute kidney injury, and chronic kidney disease), endocrine disease (hyperparathyroidism, hypothyroidism, metabolic syndrome, and diabetes mellitus), neurological effects (delirium, dementia, and Parkinson’s disease), and other effects (e.g., dermatological effects). This chapter provides an overview of the epidemiology of these effects with an emphasis on geriatric data and potential mechanisms underlying these medical effects, as well as guidance on lithium dosing and other strategies to minimize lithium-associated medical effects in older age bipolar disorder.