{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,3]],"date-time":"2026-10-03T02:38:51Z","timestamp":1790995131690,"version":"4.1.0"},"reference-count":46,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2019,6,20]],"date-time":"2019-06-20T00:00:00Z","timestamp":1560988800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000272","name":"National Institute for Health Research","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000272","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100009362","name":"South London and Maudsley NHS Foundation Trust","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100009362","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100009360","name":"King\u2019s College London","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100009360","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Bipolar Disorders"],"published-print":{"date-parts":[[2019,8]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Aims<\/jats:title><jats:p>To systematically review the existing trials on optimal serum levels for lithium for maintenance treatment of bipolar disorder and to develop clinical recommendations.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Systematic literature search. Discussion of major characteristics, limitations, methodological quality, and results of selected trials. Delphi survey consisting of clinical questions and corresponding statements. For statements endorsed by at least 80% of the members, consensus was considered as having been achieved.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>With strict inclusion criteria no studies could be selected, making it difficult to formulate evidence\u2010based recommendations. After loosening the inclusion criteria 7 trials were selected addressing our aims at least to some extent. Four of these studies suggest better efficacy being associated with lithium serum levels in a range above a lower threshold around 0.45\/0.60 and up to 0.80\/1.00\u00a0mmol\/L. These findings support the outcome of the Delphi survey.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>For adults with bipolar disorder there was consensus that the standard lithium serum level should be 0.60\u20100.80\u00a0mmol\/L with the option to reduce it to 0.40\u20100.60\u00a0mmol\/L in case of good response but poor tolerance or to increase it to 0.80\u20101.00\u00a0mmol\/L in case of insufficient response and good tolerance. For children and adolescents there was no consensus, but the majority of the members endorsed the same recommendation. For the elderly there was also no consensus, but the majority of the members endorsed a more conservative approach: usually 0.40\u20100.60\u00a0mmol\/L, with the option to go to maximally 0.70 or 0.80\u00a0mmol\/L at ages 65\u201079\u00a0years, and to maximally 0.70\u00a0mmol\/L over age 80\u00a0years.<\/jats:p><\/jats:sec>","DOI":"10.1111\/bdi.12805","type":"journal-article","created":{"date-parts":[[2019,5,22]],"date-time":"2019-05-22T00:54:49Z","timestamp":1558486489000},"page":"394-409","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":156,"title":["What is the optimal serum level for lithium in the maintenance treatment of bipolar disorder? A systematic review and recommendations from the ISBD\/IGSLI Task Force on treatment with lithium"],"prefix":"10.1111","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2092-9891","authenticated-orcid":false,"given":"Willem A.","family":"Nolen","sequence":"first","affiliation":[{"name":"Department of Psychiatry University Medical Center Groningen, University of Groningen Groningen the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rasmus W.","family":"Licht","sequence":"additional","affiliation":[{"name":"Aalborg University Hospital, Psychiatry Aalborg Denmark"},{"name":"Department of Clinical Medicine Aalborg University Aalborg Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Allan H.","family":"Young","sequence":"additional","affiliation":[{"name":"Department of Psychological Medicine Institute of Psychiatry, Psychology and Neuroscience, King's College London London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4524-9091","authenticated-orcid":false,"given":"Gin S.","family":"Malhi","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, Faculty of Medicine and Health, Northern Clinical School The University of Sydney Sydney NSW Australia"},{"name":"Academic Department of Psychiatry Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards NSW Australia"},{"name":"CADE Clinic Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards NSW Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8049-4351","authenticated-orcid":false,"given":"Mauricio","family":"Tohen","sequence":"additional","affiliation":[{"name":"Department of Psychiatry &amp; Behavioral Sciences University of New Mexico Health Sciences Center Albuquerque New Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0548-0053","authenticated-orcid":false,"given":"Eduard","family":"Vieta","sequence":"additional","affiliation":[{"name":"Bipolar Disorder Program Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM Barcelona Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ralph W.","family":"Kupka","sequence":"additional","affiliation":[{"name":"Department of Psychiatry Amsterdam UMC, Vrije Universteit, Amsterdam Public Health Institute Amsterdam the Netherlands"},{"name":"Altrecht Institute for Mental Health Care Utrecht the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carlos","family":"Zarate","sequence":"additional","affiliation":[{"name":"National Institute of Mental Health (NIMH) Bethesda Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7982-6352","authenticated-orcid":false,"given":"Ren\u00e9 E.","family":"Nielsen","sequence":"additional","affiliation":[{"name":"Aalborg University Hospital, Psychiatry Aalborg Denmark"},{"name":"Department of Clinical Medicine Aalborg University Aalborg Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ross J.","family":"Baldessarini","sequence":"additional","affiliation":[{"name":"Department of Psychiatry Harvard Medical School Boston Massachusetts"},{"name":"Mailman Research Center McLean Hospital Belmont Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emanuel","family":"Severus","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Psychotherapy University Hospital Carl Gustav Carus, TU Dresden Dresden Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"the ISBD\/IGSLI Task Force on the treatment with lithium","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2019,6,20]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.3109\/15622975.2013.770551"},{"key":"e_1_2_9_3_1","unstructured":"NICE\u20102014.Bipolar Disorder: Assessment and Management (NICE2014). 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