Department of Geriatrics, OLVG, Amsterdam, The Netherlands.
Department of Geriatrics, Reinier de Graaf Gasthuis, Delft, The Netherlands.
Int J Geriatr Psychiatry. 2021 Aug;36(8):1231-1240. doi: 10.1002/gps.5517. Epub 2021 Mar 26.
Lithium is one of the most effective treatment options in both bipolar disorder and treatment-resistant depression. The use of lithium in older patients declined during the last decades, probably resulting in undertreatment of older patients. To investigate how well lithium is tolerated in old age, we aimed to determine the frequency, reasons, and possible predictors of discontinuation due to adverse effects in a cohort of inpatients ≥60 years who had started with lithium.
We performed a retrospective cohort study based on chart reviews. Participants were in treatment at Parnassia Group at The Hague, The Netherlands. After inclusion (between January 2010 and December 2016), participants were followed until April 2017, when we performed data extraction and analysis.
In our sample of 135 patients (median age 69 years, median follow-up duration 18 months), 49 (36.3%) participants discontinued lithium. Only a minority (11 [8.1%]) of the participants discontinued solely due to adverse effects. The majority discontinued lithium due to psychiatric (18, 5%) reasons (most commonly mentioned within this subgroup: lack of effectiveness and noncompliance) or a combination of reasons (7.4%). None of the factors we studied (age, gender, Charlson Comorbidity Index, polypharmacy, renal function, and neurological history) were significantly associated with discontinuation due to adverse effects.
The frequency of lithium discontinuation in our cohort was in range with frequencies reported in younger patients. Older age itself should not be a reason to withhold lithium treatment.
锂盐是双相情感障碍和治疗抵抗性抑郁症最有效的治疗选择之一。在过去几十年中，老年患者使用锂盐的频率下降，可能导致老年患者治疗不足。为了研究锂盐在老年患者中的耐受性如何，我们旨在确定在一组开始使用锂盐的≥60 岁住院患者中，因不良反应而停药的频率、原因和可能的预测因素。
我们进行了一项基于病历回顾的回顾性队列研究。参与者在荷兰海牙的 Parnassia 集团接受治疗。纳入后（2010 年 1 月至 2016 年 12 月），参与者接受了 18 个月的随访，直到 2017 年 4 月进行数据提取和分析。
在我们的 135 名患者样本中（中位年龄 69 岁，中位随访时间 18 个月），有 49 名（36.3%）患者停止使用锂盐。仅有少数（11 名[8.1%]）患者仅因不良反应而停药。大多数患者因精神科原因（18 例，5%）停药（在该亚组中最常提到的原因是：无效和不遵医嘱）或因多种原因停药（7.4%）。我们研究的因素（年龄、性别、Charlson 合并症指数、多种药物治疗、肾功能和神经系统病史）均与因不良反应而停药无显著相关性。
我们队列中锂盐停药的频率与在年轻患者中报告的频率相当。年龄本身不应成为拒绝锂盐治疗的理由。
