Lithium prescription patterns for bipolar disorder at a psychiatric hospital in KwaZulu-Natal

Abstract

Background: Lithium is regarded as the gold standard in the treatment of bipolar disorder (BD) globally and is accordingly recommended as first-line treatment for BD in the South African public sector guidelines. However, there is a downward trend in the use of lithium internationally, with a paucity of research regarding lithium use in South Africa.
Aim: This study aimed to investigate the prescription of lithium for outpatients with BD.
Setting: Townhill Hospital, a tertiary pyschiatric hospital in Pietermaritzburg, KwaZulu- Natal.
Methods: A retrospective review of the clinical records of outpatients aged 18 and above who were treated for BD was conducted from 01 August 2022 to 31 July 2024.
Results: Of the 206 records that were reviewed, there were 137 (66.5%) females and 69 (33.5%) males with a median age of 37 years (interquartile range 30.0, 50.0). Only 13 (6.3%) of patients were taking lithium, all in combination with other medications. Most patients were prescribed oral antipsychotics (72.8%; n = 150) and anticonvulsant mood stabilisers (72.8%; n = 150), followed by antidepressants (55.8%; n = 115), alone or in combination with other psychotropics.
Conclusion: The low prescription of lithium for BD in this study is concerning, despite the long-standing evidence for lithium’s efficacy and effectiveness in the literature. This highlights the need to remind clinicians about the South African BD guidelines.
Contribution: The results of this study expand the existing literature on lithium prescribing patterns in BD internationally by contributing data on the prescription of lithium for BD in Africa.