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Cited by 86Bipolar Disorder and TreatmentSchizophrenia research and treatmentTreatment of Major Depression

Delphi survey of maintenance lithium treatment in older adults with bipolar disorder: An ISBD task force report

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Shulman, Kenneth I., Almeida, Osvaldo P., Herrmann, Nathan, Schaffer, Ayal, Strejilevich, Sergio A., Paternoster, Christina, Amodeo, Sean, Dols, Annemiek +1 more·2019·Bipolar Disorders
DOI 10.1111/bdi.12714PMC PMC6587471
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Abstract

Objectives: Despite the growing numbers and proportion of older adults with bipolar disorder (OABD), there are very limited guidelines for the use of lithium with its double‐edged potential for effectiveness and toxicity in this population. The primary aims of this Delphi survey were: (a) To determine the place of lithium among the preferred choices for maintenance treatment of OABD. (b) To provide detailed clinical guidelines for the safe and effective use of lithium in OABD. Methods: In the face of limited evidence, the Delphi survey method was used to achieve consensus by a group of 25 experts in OABD from nine countries. An oversight committee monitored and analyzed the results of each survey and formulated more focused questions with each subsequent iteration. Results: A 100% response rate was achieved for all three iterations of the survey. Lithium was the preferred choice for maintenance monotherapy in OABD. Serum levels of 0.4‐0.8 mmol/L were recommended for ages 60‐79 and serum levels of 0.4‐0.7 mmol/L were recommended for ages 80 and over. Specific recommendations achieved consensus for second line monotherapy as well as for other drugs to be used in combination with lithium if necessary. Guidelines for routine monitoring of lithium in OABD were provided for laboratory investigations and clinical assessments. Conclusions: Lithium remains the preferred choice for maintenance monotherapy in OABD. Laboratories should report the therapeutic range for serum levels of lithium separately for older adults.

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  • Before conducting the study, the authors chose a threshold that required ≥80% of experts to endorse a statement as Essential or Important, on the basis of ≥80% being a commonly employed threshold in mental health research and to be consistent with Delphi studies conducted by three independent ISBD Task Forces.

    “Before conducting the study, we chose a threshold that required ≥ 80% of experts to endorse a statement as Essential or Important, on the basis of ≥ 80% being a commonly employed threshold in mental health research [47, 48, 49], and to be consistent with Delphi studies conducted by three independent ISBD Task Forces [50, 51, 52].”

    From Essential Information About Chronobiology and Chronotherapy for the Optimal Care of People With Bipolar Disorders: An Expert Consensus (2026) · cites this paper as [51]

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Authors
Shulman, K. I., Almeida, O. P., Herrmann, N., Schaffer, A., Strejilevich, S. A., Paternoster, C., Amodeo, S., Dols, A., & Sajatovic, M.
Affiliations
  • Sunnybrook Health Science Centre (CA)
  • The University of Western Australia (AU)
  • Favaloro University (AR)
  • International Society of Bipolar Disorders (US)
  • GGZ inGeest (NL)
  • University Hospitals Cleveland Medical Center (US)
Corresponding author
Shulman, Kenneth I.
ORCID
Venue
Bipolar Disorders
Publisher
Wiley
Published
2018-11-16
Volume
21
Issue
2
Pages
117-123
ISSN
  • 1398-5647 (ISSN-L)
  • 1399-5618
DOI
10.1111/bdi.12714
PMC
PMC6587471
OpenAlex
W2898775361
Cited by
86
References
41
Citations by year
2026: 21 · 2025: 9 · 2024: 13 · 2023: 16 · 2022: 6 · 2021: 7 · 2020: 8 · 2019: 6
FWCI
4.12
Type
journal article
Language
en
Open access
Licence
Locations
  • Bipolar Disorders (publishedVersion, cc-by-nc)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by-nc)
  • PubMed Central (publishedVersion, cc-by-nc)
  • PubMed (publishedVersion)
  • Amsterdam UMC (VU Amsterdam) - Institutional Repository (publishedVersion, other-oa)
  • Pure Amsterdam UMC (submittedVersion, other-oa)
  • Scholarly Commons @ Case Western Reserve University (submittedVersion, cc-by-nc)
  • UWA Profiles and Research Repository (UWA) (submittedVersion, cc-by-nc)
  • Data Archiving and Networked Services (DANS) (submittedVersion, other-oa)
Topics
  • Health Sciences › Medicine › Psychiatry and Mental health › Bipolar Disorder and Treatment
  • Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
  • Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
Keywords
bipolar disorder, older adults, lithium, maintenance therapy, serum lithium levels, therapeutic window, lithium toxicity, expert consensus, lithium monitoring, combination therapy
MeSH terms
Age Factors, Aged, Aged, 80 and over, Bipolar Disorder, Delphi Technique, Humans, Middle Aged, Surveys and Questionnaires, Practice Guidelines as Topic, Lithium Compounds, Advisory Committees

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