{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T22:14:23Z","timestamp":1787004863907,"version":"build-2736575974"},"reference-count":39,"publisher":"Georg Thieme Verlag KG","issue":"05","license":[{"start":{"date-parts":[[2023,7,28]],"date-time":"2023-07-28T00:00:00Z","timestamp":1690502400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pharmacopsychiatry"],"published-print":{"date-parts":[[2023,9]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Introduction While lithium (Li) has been well established for the\n                    treatment of bipolar disorder, geriatric patients require special attention when\n                    it comes to issues of drug safety. Declining renal function, amongst other\n                    medical conditions, and polypharmacy may pose increased risks. Only a few\n                    previous studies have addressed the management of Li in geriatric patients.<\/jats:p>\n                  <jats:p>Methods Twenty-four German medical experts on geriatric medicine and Li\n                    treatment participated in a Delphi survey, consisting of two rounds of\n                    questionnaires and a final formulation of treatment recommendations. Three major\n                    issues of Li therapy were outlined: initiation of treatment, monitoring of\n                    ongoing therapy, and withdrawal due to medical reasons. Final recommendations\n                    were consented to at a threshold of at least 80% expert agreement.<\/jats:p>\n                  <jats:p>Results Final consensus was achieved on 21 clinical recommendations. The\n                    approved recommendations covered aspects of necessary laboratory checks,\n                    concomitant medication, and target Li serum concentration in geriatric patients.\n                    Concerning the termination of Li therapy, an agreement was reached on the\n                    appropriate time span for tapering and on potential alternatives to Li. No\n                    consensus was achieved on whether concomitant dementia or frailty should be\n                    considered contraindications for Li treatment and the appropriate threshold of\n                    the estimated glomerular function rate for withdrawing Li.<\/jats:p>\n                  <jats:p>Conclusion According to the view of German experts, Li may be used in\n                    geriatric patients, but it should be monitored carefully. However, the lack of\n                    consent in several specific treatment situations underlines the need for\n                    research on specific issues of Li therapy.<\/jats:p>","DOI":"10.1055\/a-2117-5200","type":"journal-article","created":{"date-parts":[[2023,7,28]],"date-time":"2023-07-28T18:46:09Z","timestamp":1690569969000},"page":"188-196","source":"Crossref","is-referenced-by-count":4,"title":["Lithium Therapy in Old Age: Recommendations from a Delphi\n                    Survey"],"prefix":"10.1055","volume":"56","author":[{"given":"Julia","family":"Christl","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Psychotherapy, Medical Faculty,\n                    Heinrich-Heine-University, D\u00fcsseldorf, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bruno","family":"M\u00fcller-Oerlinghausen","sequence":"additional","affiliation":[{"name":"Charit\u00e9 Universit\u00e4tsmedizin Berlin, Berlin,\n                    Germany"},{"name":"Brandenburg Medical School Theodor Fontane, Faculty of Medicine and\n                    Psychology, Neuruppin, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Bauer","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Psychotherapy, University Hospital Carl\n                    Gustav Carus, Medical Faculty, Technische Universit\u00e4t Dresden, Dresden,\n                    Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Kamp","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Psychotherapy, Medical Faculty,\n                    Heinrich-Heine-University, D\u00fcsseldorf, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fabian","family":"Fu\u00dfer","sequence":"additional","affiliation":[{"name":"Klinik f\u00fcr Gerontopsychiatrie, Psychosomatik und\n                    Psychotherapie, Pfalzklinikum Klingenm\u00fcnster, Klingenm\u00fcnster,\n                    Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jens","family":"Benninghoff","sequence":"additional","affiliation":[{"name":"Zentrum f\u00fcr Altersmedizin und Entwicklungsst\u00f6rungen,\n                    kbo-Isar-Amper-Klinikum M\u00fcnchen-Ost, Haar, Germany"},{"name":"LVR-Universit\u00e4tsklinik Essen, Kliniken und Institut der\n                    Universit\u00e4t Duisburg-Essen, Essen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rosa A.","family":"Fehrenbach","sequence":"additional","affiliation":[{"name":"Saarland-Heilst\u00e4tten GmbH, SHG-Kliniken Sonnenberg, Klinik\n                    f\u00fcr Gerontopsychiatrie, Saarbr\u00fccken, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian","family":"Lange-Asschenfeldt","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Psychotherapy, Medical Faculty,\n                    Heinrich-Heine-University, D\u00fcsseldorf, Germany"},{"name":"Oberberg Fachklinik D\u00fcsseldorf Kaarst, Kaarst,\n                    Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Rapp","sequence":"additional","affiliation":[{"name":"University of Potsdam, Research Area Cognitive Sciences, Division of\n                    Social and Preventive Medicine, Potsdam, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bernd","family":"Ibach","sequence":"additional","affiliation":[{"name":"Zentrum f\u00fcr Alterspsychiatrie und Priv\u00e9, Clienia\n                    Littenheid AG, Littenheid und Universit\u00e4t Z\u00fcrich,\n                    Z\u00fcrich, Schweiz"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rainer","family":"Schaub","sequence":"additional","affiliation":[{"name":"Klinik f\u00fcr Gerontopsychiatrie und Psychotherapie, Klinikum am\n                    Weissenhof, Weinsberg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Axel","family":"Wollmer","sequence":"additional","affiliation":[{"name":"Klinik f\u00fcr Gerontopsychiatrie und Psychotherapie, Asklepios\n                    Klinik Nord-Ochsenzoll, Hamburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Timm","family":"Strotmann-Tack","sequence":"additional","affiliation":[{"name":"Klinik f\u00fcr Gerontopsychiatrie und Psychotherapie, LVR-Klinik\n                    Viersen, Viersen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"H\u00fcll","sequence":"additional","affiliation":[{"name":"Zentrum f\u00fcr Psychiatrie Emmendingen, Emmendingen,\n                    Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susanne","family":"Biermann","sequence":"additional","affiliation":[{"name":"LWL-Klinik Lengerich, Lengerich, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katharina","family":"Roscher","sequence":"additional","affiliation":[{"name":"Psychiatrische Klinik L\u00fcneburg, L\u00fcneburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bernd","family":"Meissnest","sequence":"additional","affiliation":[{"name":"LWL-Klinikum G\u00fctersloh, G\u00fctersloh,\n                    Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander","family":"Menges","sequence":"additional","affiliation":[{"name":"Klinikum Freudenstadt, Freudenstadt, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bernd","family":"Weigel","sequence":"additional","affiliation":[{"name":"Bezirksklinikum Mainkofen, Mainkofen, Deggendorf, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dorothee","family":"Maliszewski-Makowka","sequence":"additional","affiliation":[{"name":"LVR-Klinik Bedburg-Hau, Bedburg-Hau, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian","family":"Mauerer","sequence":"additional","affiliation":[{"name":"Bezirkskrankenhaus Bayreuth, Bayreuth, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin","family":"Schaefer","sequence":"additional","affiliation":[{"name":"Klinik f\u00fcr Psychiatrie, Psychotherapie, Psychosomatik und\n                    Suchtmedizin, Evang. Kliniken Essen-Mitte, Essen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Beate","family":"Joachimsmeier","sequence":"additional","affiliation":[{"name":"LWL Klinik Paderborn, Paderborn, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah","family":"Kayser","sequence":"additional","affiliation":[{"name":"Klinik f\u00fcr Allgemeine Psychiatrie und Psychotherapie mit\n                    Poliklinik Universit\u00e4tsklinikum T\u00fcbingen, T\u00fcbingen,\n                    Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lars Christian","family":"Rump","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Medical Faculty, University Hospital\n                    D\u00fcsseldorf, Heinrich-Heine-University D\u00fcsseldorf,\n                    D\u00fcsseldorf, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tillmann","family":"Supprian","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Psychotherapy, Medical Faculty,\n                    Heinrich-Heine-University, D\u00fcsseldorf, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2023,7,28]]},"reference":[{"key":"ref2","doi-asserted-by":"crossref","first-page":"97","DOI":"10.1111\/bdi.12609","article-title":"Canadian Network for Mood and Anxiety Treatments (CANMAT) and International\n                    Society for Bipolar Disorders (ISBD) 2018 guidelines for the management of\n                    patients with bipolar disorder","volume":"20","author":"L N Yatham","year":"2018","journal-title":"Bipolar Disord"},{"key":"ref4","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1186\/s40345-019-0151-2","article-title":"Clinical use of lithium salts: Guide for users and prescribers","volume":"7","author":"L Tondo","year":"2019","journal-title":"Int J Bipolar Disord"},{"key":"ref5","doi-asserted-by":"crossref","first-page":"689","DOI":"10.1111\/bdi.12331","article-title":"A report on older-age bipolar disorder from the International Society for\n                    Bipolar Disorders Task Force","volume":"17","author":"M Sajatovic","year":"2015","journal-title":"Bipolar Disord"},{"key":"ref6","doi-asserted-by":"crossref","first-page":"305","DOI":"10.1097\/00019442-200504000-00006","article-title":"Maintenance treatment outcomes in older patients with bipolar I disorder","volume":"13","author":"M Sajatovic","year":"2005","journal-title":"Am J Geriatr Psychiatry"},{"key":"ref7","doi-asserted-by":"crossref","first-page":"1086","DOI":"10.1176\/appi.ajp.2017.15050657","article-title":"GERI-BD: A randomized double-blind controlled trial of lithium and divalproex in\n                    the treatment of mania in older patients with bipolar disorder","volume":"174","author":"R C Young","year":"2017","journal-title":"Am J Psychiatry"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"1177","DOI":"10.4088\/jcp.v68n080.3","article-title":"Lithium augmentation compared with\n                    phenelzine in treatment-resistant depression in the elderly: an open,\n                    randomized controlled trial","volume":"68","author":"R M Kok","year":"2007","journal-title":"J Clin Psychiatry"},{"key":"ref9","doi-asserted-by":"crossref","first-page":"619","DOI":"10.1002\/gps.671","article-title":"Prophylactic therapy with lithium in elderly patients with unipolar major\n                    depression","volume":"17","author":"D Wilkinson","year":"2002","journal-title":"Int J Geriatr Psychiatry"},{"key":"ref10","doi-asserted-by":"crossref","first-page":"442","DOI":"10.1111\/acps.13474","article-title":"on behalf of the GAGE-BD initiative. Demografic and clinical characteristics of\n                    Lithium-treated older adults with bipolar disorder","volume":"146","author":"O Forlenza","year":"2022","journal-title":"Acta Psychiatr Scand"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"510","DOI":"10.1111\/acps.13153","article-title":"Risk of dementia in bipolar disorder and the interplay of lithium: A systematic\n                    review and meta-analyses","volume":"141","author":"J Velosa","year":"2020","journal-title":"Acta Psychiatr Scand"},{"key":"ref12","doi-asserted-by":"crossref","first-page":"960","DOI":"10.1136\/bmj.326.7396.960","article-title":"Changing prescription patterns for lithium and valproic acid in old age:\n                    Shifting practice without evidence","volume":"326","author":"K I Shulman","year":"2003","journal-title":"BMJ"},{"key":"ref13","doi-asserted-by":"crossref","first-page":"117","DOI":"10.1111\/bdi.12714","article-title":"Delphi survey of maintenance lithium treatment in older adults with bipolar\n                    disorder: An ISBD task force report","volume":"21","author":"K I Shulman","year":"2019","journal-title":"Bipolar Disord"},{"key":"ref14","doi-asserted-by":"crossref","first-page":"1295","DOI":"10.1002\/gps.4534","article-title":"International Society for Bipolar Disorders Task Force for Older Adults with\n                    Bipolar Disorder. Do current national and international guidelines have specific\n                    recommendations for older adults with bipolar disorder? A brief report","volume":"31","author":"A Dols","year":"2016","journal-title":"Int J Geriatr Psychiatry"},{"key":"ref16","doi-asserted-by":"crossref","first-page":"347","DOI":"10.1001\/jamapsychiatry.2017.4711","article-title":"Real-world effectiveness of pharmacologic treatments for the prevention of\n                    rehospitalization in a Finnish nationwide cohort of patients with bipolar\n                    disorder","volume":"75","author":"M Lahteenvuo","year":"2018","journal-title":"JAMA Psychiatry"},{"key":"ref17","doi-asserted-by":"crossref","first-page":"36","DOI":"10.1159\/000314308","article-title":"Lithium\u2019s emerging role in the treatment of refractory major depressive\n                    episodes: Augmentation of antidepressants","volume":"62","author":"M Bauer","year":"2010","journal-title":"Neuropsychobiology"},{"key":"ref18","doi-asserted-by":"crossref","first-page":"136","DOI":"10.1016\/j.jad.2019.03.057","article-title":"Treatment response of lithium augmentation in geriatric compared to\n                    non-geriatric patients with treatment-resistant depression","volume":"215","author":"P Buspavanich","year":"2019","journal-title":"J Affect Disord"},{"key":"ref19","doi-asserted-by":"crossref","first-page":"681","DOI":"10.1176\/appi.ajp.2011.10081165","article-title":"A systematic review of treatments for refractory depression in older people","volume":"168","author":"C Cooper","year":"2011","journal-title":"Am J Psychiatry"},{"key":"ref20","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1186\/s40345-017-0080-x","article-title":"Lithium in the episode and suicide prophylaxis and in augmenting strategies in\n                    patients with unipolar depression","volume":"5","author":"M T Abou-Saleh","year":"2017","journal-title":"Int J Bipolar Disord"},{"key":"ref21","doi-asserted-by":"crossref","first-page":"f3646","DOI":"10.1136\/bmj.f3646","article-title":"Lithium in the prevention of suicide in mood disorders: Updated systematic\n                    review and meta-analysis","volume":"346","author":"A Cipriani","year":"2013","journal-title":"BMJ"},{"key":"ref22","doi-asserted-by":"crossref","first-page":"795","DOI":"10.1176\/appi.ajp.2017.16050542","article-title":"Suicidal behavior during Lithium and Valproate treatment: A within-individual\n                    8-year prospective study of 50.000 patients with bipolar disorder","volume":"174","author":"J Song","year":"2017","journal-title":"Am J Psychiatry"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"230","DOI":"10.3390\/cells10020230","article-title":"Parkinson's disease: Potential actions of lithium by targeting the\n                    WNT\/\u03b2-catenin pathway, oxidative stress, inflammation and\n                    glutamatergic pathway","volume":"25","author":"A Vall\u00e9e","year":"2021","journal-title":"Cells"},{"key":"ref24","doi-asserted-by":"crossref","first-page":"403","DOI":"10.3389\/fnins.2015.00403","article-title":"Potential application of lithium in Parkinson\u2019s and other\n                    neurodegenerative diseases","volume":"9","author":"C A Lazzara","year":"2015","journal-title":"Front Neurosci"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"385","DOI":"10.1002\/hbm.25249","article-title":"In vivo hippocampal subfield volumes in bipolar disorder-A mega-analysis from\n                    The Enhancing Neuro Imaging Genetics through Meta-Analysis Bipolar Disorder\n                    Working Group","volume":"43(1)","author":"U K Haukvik","year":"2022","journal-title":"Hum Brain Mapp"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"394","DOI":"10.1111\/bdi.12805","article-title":"What is the optimal serum level for lithium in the maintenance treatment of\n                    bipolar disorder? A systematic review and recommendations from the\n                    ISBD\/IGSLI Task Force on treatment with lithium","volume":"21","author":"W A Nolen","year":"2019","journal-title":"Bipolar Disord"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"911","DOI":"10.1007\/s40266-014-0221-1","article-title":"Lithium dosing and serum concentrations across the age spectrum: from early\n                    adulthood to the tenth decade of life","volume":"31","author":"S Rej","year":"2014","journal-title":"Drugs Aging"},{"key":"ref28","doi-asserted-by":"crossref","first-page":"165","DOI":"10.2165\/00002512-200016030-00002","article-title":"Differential pharmacokinetics of lithium in elderly patients","volume":"16","author":"B A Sproule","year":"2000","journal-title":"Drugs Aging"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"51","DOI":"10.1177\/0891988712436690","article-title":"The effects of lithium on renal function in older adults\u2013a systematic\n                    review","volume":"25","author":"S Rej","year":"2012","journal-title":"J Geriatr Psychiatry Neurol"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"288","DOI":"10.1097\/MJT.0b013e3181d070c3","article-title":"Improving tolerability of lithium with a once-daily dosing schedule","volume":"18","author":"L K Singh","year":"2011","journal-title":"Am J Ther"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"1265","DOI":"10.1373\/clinchem.2015.243030","article-title":"Performance of cystatin C- and creatinine-based estimated glomerular filtration\n                    rate equations depends on patient characteristics","volume":"61","author":"J W Meeusen","year":"2015","journal-title":"Clin Chem"},{"key":"ref32","doi-asserted-by":"crossref","first-page":"73","DOI":"10.3109\/00365513.2011.634023","article-title":"Improved estimation of glomerular filtration rate (GFR) by comparison of\n                    eGFRcystatin C and eGFRcreatinine","volume":"72","author":"A Grubb","year":"2012","journal-title":"Scand J Clin Lab Invest"},{"key":"ref33","first-page":"189","article-title":"\u201cMini-mental state\u201d. 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