{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T16:32:46Z","timestamp":1786120366002,"version":"build-2736575974"},"reference-count":40,"publisher":"Georg Thieme Verlag KG","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pharmacopsychiatry"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Introduction Lithium is a well-evidenced option for treatment-resistant\n                    unipolar depression. However, its use has globally declined over the past two\n                    decades and there is little evidence on exactly how unpopular the unipolar\n                    augmentation strategy is on the nosological characteristics of patients who\n                    still receive it and on primary agents. Real-world epidemiological studies can\n                    provide key relevant insights.<\/jats:p>\n                  <jats:p>Methods We analysed all ICD-10 unipolar depression prescriptions in Greece\n                    in the period between 1\/2\/2019 and 31\/1\/2020 and identified unipolar depression\n                    patients who were prescribed lithium. To benchmark lithium rates against those\n                    of other alternatives, we estimated quetiapine and aripiprazole prescription\n                    rates in unipolar depression. Logistic regression models were used to locate the\n                    diagnostic predictors of lithium prescription. Polypharmacy patterns and\n                    co-prescription of potentially interacting drugs were examined.<\/jats:p>\n                  <jats:p>ResultsOnly 1,314 patients (0.174%) with unipolar depression were\n                    prescribed lithium, representing a small fraction of the assumed 30% of patients\n                    expected to have treatment-resistant depression. This was substantially lower\n                    than quetiapine (7.1%) and aripiprazole (1.1%) prescription rates for unipolar\n                    depression. Patients who were prescribed lithium were younger, more often men,\n                    and mostly managed by psychiatrists. More severe disorder profiles were apparent\n                    (24% vs. 6%), with psychotic symptoms and mixed symptomatology more prevalent.\n                    The sensitivity analysis showed that, after excluding patients prescribed\n                    lithium who received a diagnosis suggestive of bipolarity within the same\n                    period, only 785 patients (0.108%) consistently received unipolar diagnoses,\n                    with a further drop when other major diagnoses are factored in (0.08%). One in\n                    13 people received a possibly interacting drug, especially thiazide\n                    diuretics.<\/jats:p>\n                  <jats:p>Discussion Despite strong evidence for augmentation in treatment-resistant\n                    unipolar depression, lithium prescription remains an underappreciated treatment\n                    option. In Greece, it is reserved for severe cases, together with selective\n                    serotonin reuptake inhibitors\/serotonin and norepinephrine reuptake inhibitors\n                    and atypical antipsychotics. Possible reasons include a perception of\n                    alternatives as safer, further complicated by supply issues.<\/jats:p>","DOI":"10.1055\/a-2924-4384","type":"journal-article","created":{"date-parts":[[2026,8,6]],"date-time":"2026-08-06T22:58:41Z","timestamp":1786057121000},"source":"Crossref","is-referenced-by-count":0,"title":["Lithium Prescription in Unipolar Depression: Findings from a\n                    Nationwide Greek Cohort Study"],"prefix":"10.1055","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7173-9967","authenticated-orcid":false,"given":"Vasilios","family":"Karageorgiou","sequence":"additional","affiliation":[{"name":"University of Athens, Greece","place":["Athens"],"department":["Second Department of Psychiatry"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ioannis","family":"Michopoulos","sequence":"additional","affiliation":[{"name":"University of Athens, Greece","place":["Athens"],"department":["Second Department of Psychiatry"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michail","family":"Hadjulis","sequence":"additional","affiliation":[{"name":"National and Kapodistrian University of Athens Faculty\n                    of Nursing, Attica, Greece","place":["Athens"],"department":["Department of Psychiatry, Agioi Anargyroi Hospital"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Panagiota","family":"Mitrou","sequence":"additional","affiliation":[{"name":"Hellenic Republic Ministry of Health and Social\n                    Solidarity, Attica, Greece","place":["Athens"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eleftherios","family":"Thireos","sequence":"additional","affiliation":[{"name":"National Agency for Quality Assurance in Health S.A., Greece","place":["Athens"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Konstantinos","family":"Mathioudakis","sequence":"additional","affiliation":[{"name":"IDIKA SA \u2013 e-Government Center for Social Security\n                    Services, Greece","place":["Athens"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Petros","family":"Skapinakis","sequence":"additional","affiliation":[{"name":"University of Ioannina, Ipiros Ditiki Makedonia, Greece","place":["Ioannina"],"department":["Department of Psychiatry"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rossetos","family":"Gournellis","sequence":"additional","affiliation":[{"name":"University of Athens, Greece","place":["Athens"],"department":["Second Department of Psychiatry"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2026,8,6]]},"reference":[{"issue":"06","key":"ref1","doi-asserted-by":"crossref","first-page":"495","DOI":"10.1177\/0269881116636545","article-title":"Evidence-based guidelines for treating bipolar disorder: Revised third edition\n                    recommendations from the british association for psychopharmacology","volume":"30","author":"G M Goodwin","year":"2016","journal-title":"J Psychopharmacol"},{"issue":"01","key":"ref2","doi-asserted-by":"crossref","first-page":"1","DOI":"10.21307\/ane-2017-001","article-title":"Lithium\u2014therapeutic tool endowed with multiple ben-eficiary effects caused by\n                    multiple mechanisms","volume":"76","author":"M Vosahlikova","year":"2016","journal-title":"Acta Neurobiol Exp"},{"issue":"02","key":"ref3","doi-asserted-by":"crossref","first-page":"167","DOI":"10.1177\/0269881118822161","article-title":"Lithium treatment for unipolar major depressive disorder: Systematic review","volume":"33","author":"J Undurraga","year":"2019","journal-title":"J Psychopharmacol"},{"issue":"07","key":"ref4","doi-asserted-by":"crossref","first-page":"575","DOI":"10.1111\/bdi.12543","article-title":"Lithium and suicide in mood disorders: Updated meta-review of the scientific\n                    literature","volume":"19","author":"K A Smith","year":"2017","journal-title":"Bipolar Disord"},{"issue":"05","key":"ref5","doi-asserted-by":"crossref","first-page":"459","DOI":"10.1177\/0269881115581093","article-title":"Evidence-based guidelines for treating depressive disorders with\n                    antidepressants: A revision of the 2008 british association for\n                    psychopharmacology guidelines","volume":"29","author":"A Cleare","year":"2015","journal-title":"J Psychopharmacol"},{"issue":"08","key":"ref6","doi-asserted-by":"crossref","first-page":"890","DOI":"10.1177\/02698811211013579","article-title":"Efficacy and tolerability of combination treatments for major depression:\n                    Antidepressants plus second-generation antipsychotics vs. esketamine vs.\n                    lithium","volume":"35","author":"G H. 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