Journal Article Annotations
2023, 1st Quarter
Annotations by Sahil Munjal, MD
This study examined adult bipolar patients on long term lithium therapy (>1yr) who developed chronic kidney disease (CKD) stage 3. Patients who discontinued lithium were compared to those who continued lithium two years post-CKD diagnosis. For discontinuers, time to the first mood episode was significantly shorter and the likelihood of a mood episode was significantly increased (61% vs 10%).
Strength and weaknesses:
A study strength was that it was a mirror-image study design in which patients served as their own controls, comparing previous and subsequent treatment periods, which minimized multiple confounding variables. Weaknesses included the observational study design with a small sample size (n=38) and a short duration follow up of two years.
It is well known that lithium remains the gold standard when it comes to treatment of bipolar disorder. However, it remains underutilized, in part of its well-established association with worsening kidney function. For patients on long term lithium that have already developed CKD, controversy remains as to the next steps. This study adds to a growing list of evidence pointing towards worsening mental health outcomes in lithium discontinuers. The authors do highlight strategies to minimize lithium’s adverse kidney effects by avoiding nephrotoxins, maintaining low serum levels, once a day dosing of lithium and regular monitoring of kidney function. CL psychiatrists should discuss the increased risk of mood destabilization in patients considering lithium discontinuation.
Type of study (EBM guide):