Evidence map›Paper›PMID 31112628›Full record

SynthesisBipolar disorders2019

What is the optimal serum level for lithium in the maintenance treatment of bipolar disorder? A systematic review and recommendations from the ISBD/IGSLI Task Force on treatment with lithium.

Willem A Nolen, Rasmus W Licht, Allan H Young, Gin S Malhi, Mauricio Tohen, Eduard Vieta, Ralph W Kupka, Carlos Zarate, René E Nielsen, Ross J Baldessarini and 2 more

Abstract readSystematic Review
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in Bipolar disorders, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 58 papers, 4 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
58citing papers in PubMed, 4 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

58 citing papers in PubMed, 4 syntheses or guidelines pooled it.

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  11. A one-compartment model provides benchmark Lithium dose prediction.Journal of psychopharmacology (Oxford, England) · 2026
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4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

12 authors.

Willem A NolenDepartment of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.ORCID 0000-0002-2092-9891
Rasmus W LichtAalborg University Hospital, Psychiatry, Aalborg, Denmark.
Allan H YoungDepartment of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
Gin S MalhiDepartment of Psychiatry, Faculty of Medicine and Health, Northern Clinical School, The University of Sydney, Sydney, NSW, Australia.ORCID 0000-0002-4524-9091
Mauricio TohenDepartment of Psychiatry & Behavioral Sciences, University of New Mexico Health Sciences Center, Albuquerque, New Mexico.ORCID 0000-0001-8049-4351
Eduard VietaBipolar Disorder Program, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Spain.ORCID 0000-0002-0548-0053
Ralph W KupkaDepartment of Psychiatry, Amsterdam UMC, Vrije Universteit, Amsterdam Public Health Institute, Amsterdam, the Netherlands.
Carlos ZarateNational Institute of Mental Health (NIMH), Bethesda, Maryland.
René E NielsenAalborg University Hospital, Psychiatry, Aalborg, Denmark.ORCID 0000-0002-7982-6352
Ross J BaldessariniDepartment of Psychiatry, Harvard Medical School, Boston, Massachusetts.
Emanuel SeverusDepartment of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany.
ISBD/IGSLI Task Force on the treatment with lithium

Funding

Intramural NIH HHS Z99 MH999999
6 · The paper itself

Abstract

aimsTo systematically review the existing trials on optimal serum levels for lithium for maintenance treatment of bipolar disorder and to develop clinical recommendations.

methodsSystematic literature search. Discussion of major characteristics, limitations, methodological quality, and results of selected trials. Delphi survey consisting of clinical questions and corresponding statements. For statements endorsed by at least 80% of the members, consensus was considered as having been achieved.

resultsWith strict inclusion criteria no studies could be selected, making it difficult to formulate evidence-based recommendations. After loosening the inclusion criteria 7 trials were selected addressing our aims at least to some extent. Four of these studies suggest better efficacy being associated with lithium serum levels in a range above a lower threshold around 0.45/0.60 and up to 0.80/1.00 mmol/L. These findings support the outcome of the Delphi survey.

conclusionsFor adults with bipolar disorder there was consensus that the standard lithium serum level should be 0.60-0.80 mmol/L with the option to reduce it to 0.40-0.60 mmol/L in case of good response but poor tolerance or to increase it to 0.80-1.00 mmol/L in case of insufficient response and good tolerance. For children and adolescents there was no consensus, but the majority of the members endorsed the same recommendation. For the elderly there was also no consensus, but the majority of the members endorsed a more conservative approach: usually 0.40-0.60 mmol/L, with the option to go to maximally 0.70 or 0.80 mmol/L at ages 65-79 years, and to maximally 0.70 mmol/L over age 80 years.

Indexed as

Advisory CommitteesBipolar DisorderConsensusDrug ToleranceHumansLithium CompoundsPractice Guidelines as TopicSurveys and QuestionnairesLithium Compoundsbipolar disorderLithiummaintenance treatmentserum level

Identifiers

PMID31112628
PMCPMC6688930

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.