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Neuropsychiatr Dis Treat. 2017 Mar 9;13:755-766. doi: 10.2147/NDT.S126708. eCollection 2017.

Lithium in late-life mania: a systematic review.

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Department of Health Sciences, Psychiatric Unit, University Magna Græcia of Catanzaro.
Department of Health Science, University Magna Græcia.
Department of Health Sciences, Institute of Pharmacology, University Magna Græcia, Catanzaro.
Department of Molecular Medicine, Division of Psychiatry, University of Siena, Siena, Italy.


The prevalence of mania among >65-year-olds ranges from 0.1% to 0.4% and its treatment is a particular challenge for clinicians. Although lithium is the treatment of choice for bipolar disorder (BD), its use in elderly population was recently questioned. This study provides a comprehensive review of literature on the efficacy and tolerability of lithium as a pharmacologic treatment for mania in elderly BD patients. We conducted a systematic review, based on PRISMA guidelines, of articles published between 1970 and August 2016 and indexed in the following databases: EMBASE, MEDLINE, Cochrane Library Databases and PsycINFO. The key words "age", "late-life", "geriatric", "elderly", and "older" were combined with words indicating pharmacologic treatments, such as lithium and other mood stabilizers and with the diagnostic terms "bipolar disorder" and "mania". Fifteen out of 196 retrieved studies met our inclusion criteria. Seven studies evaluated both the efficacy and tolerability of lithium treatment in elderly BD patients; a further three evaluated only the efficacy and five assessed tolerability. Only limited data on the treatment of elderly BD patients are available, but evidence suggests that lithium is effective and tolerated in this subgroup of patients and thus should remain a first-line drug. It seems to be more effective at lower doses and close monitoring of plasma concentrations is necessary.


bipolar disorder; efficacy; elderly; late-life mania; lithium; tolerability

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