When considering pharmacological management of mood disorders, the peripartum period, childhood, and old age, should be considered as special clinical conditions that deviate from the normal distribution of patient characteristics.4 In pregnancy, weighing any risks to the foetus against the benefits to the mother in stabilizing mood is important.1 More studies are required for the management of bipolar disorder in the paediatric and old age population.4 Particularly, there appears to be a lack of studies assessing the efficacy of lithium on relapse prevention and cognitive symptoms in older age patients with bipolar disorder.4
References:
1. Singh S, Deep R. Pharmacological treatment of bipolar disorder in pregnancy: an update on safety considerations. Indian J Pharmacol 2022; 54 (6): 443–451.
2. US Food and Drug Administration. FDA drug safety communication: antipsychotic drug labels updated on use during pregnancy and risk of abnormal muscle movements and withdrawal symptoms in newborns. 22 February 2011. Available at: https://www.fda.gov/drugs/drug-safety-and-availability/fda-drug-safety-communication-antipsychotic-drug-labels-updated-use-during-pregnancy-and-risk. Accessed 26 February 2024.
3. Fornaro M, Maritan E, Ferranti R, et al. Lithium exposure during pregnancy and the postpartum period: a systematic review and meta-analysis of safety and efficacy outcomes. Am J Psychiatry 2020; 177 (1): 76–92.
4. Janiri D, Sampogna G, Albert U, et al. Lithium use in childhood and adolescence, peripartum, and old age: an umbrella review. Int J Bipolar Disord 2023; 11 (1): 8.
5. DelBello MP, Kadakia A, Heller V, et al. Systematic review and network meta-analysis: efficacy and safety of second-generation antipsychotics in youths with bipolar depression. J Am Acad Child Adolesc Psychiatry 2022; 61 (2): 243–254.
6. Chan BS, Cheng S, Isoardi KZ, et al. Effect of age on the severity of chronic lithium poisoning. Clin Toxicol (Phila) 2020; 58 (11): 1023–1027.
7. Ishii N, Terao T, Hirakawa H. The present state of lithium for the prevention of dementia related to Alzheimer’s dementia in clinical and epidemiological studies: a critical review. Int J Environ Res Public Health 2021; 18 (15): 7756.
8. Velosa J, Delgado A, Finger E, et al. Risk of dementia in bipolar disorder and the interplay of lithium: a systematic review and meta-analyses. Acta Psychiatr Scand 2020; 141 (6): 510–521.
9. Ljubic N, Ueberberg B, Grunze H, Assion HJ. Treatment of bipolar disorders in older adults: a review. Ann Gen Psychiatry 2021; 20 (1): 45.