The British Journal of Psychiatry
Starting lithium prophylaxis early v. late in bipolar disorder
Lars Vedel Kessing, Eleni Vradi, Per Kragh Andersen
  • Declaration of interest

    L.V.K. has within the preceding 3 years been a consultant for Lundbeck and AstraZeneca.



No study has investigated when preventive treatment with lithium should be initiated in bipolar disorder.


To compare response rates among patients with bipolar disorder starting treatment with lithium early v. late.


Nationwide registers were used to identify all patients with a diagnosis of bipolar disorder in psychiatric hospital settings who were prescribed lithium during the period 1995-2012 in Denmark (n = 4714). Lithium responders were defined as patients who, following a stabilisation lithium start-up period of 6 months, continued lithium monotherapy without being admitted to hospital. Early v. late intervention was defined in two ways: (a) start of lithium following first contact; and (b) start of lithium following a diagnosis of a single manic/mixed episode.


Regardless of the definition used, patients who started lithium early had significantly decreased rates of non-response to lithium compared with the rate for patients starting lithium later (adjusted analyses: first v. later contact: P<0.0001; hazard ratio (HR) = 0.87, 95% CI 0.76-0.91; single manic/mixed episode v. bipolar disorder: P<0.0001; HR = 0.75, 95% CI 0.67-0.84).


Starting lithium treatment early following first psychiatric contact or a single manic/mixed episode is associated with increased probability of lithium response.


  • Funding

    NARSAD Distinguished Investigator Grant 2012, Brain & Behavior Research Foundation, New York, USA, awarded to L.V.K.

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