Provider Perspectives on the Current Use of Lithium Medications and Lithium Monitoring Practices for Psychiatric Conditions

Abstract

Purpose

Despite lithium being a gold standard treatment for bipolar disorder, the percentage of patients with bipolar disorder who are prescribed lithium medication has declined in many parts of the world over the past two decades. The use of lithium is limited by its narrow therapeutic window and adverse side effects, which necessitates frequent serum lithium monitoring; hence, there is a critical need for improved ways to monitor lithium levels in psychiatric patients. We have recently shown that saliva lithium levels are highly correlated with those in blood, thereby presenting an alternative to venipuncture. Saliva sampling could open the door for at-home collections – potential that has been exemplified throughout the COVID-19 pandemic – thereby allowing samples to be collected remotely and delivered to a specific site for testing. In addition, prototype point-of-care devices have been developed by others for serum lithium monitoring, suggesting potential for a saliva lithium monitoring device. Our objective was to query the perspectives of American psychiatrists on lithium treatment practices and obstacles, the potential for at-home saliva collection and point-of-care devices, for lithium monitoring, as an alternative to pathology-based blood testing.

Methods

Data was collected through an online, anonymous survey, distributed to American psychiatric societies.

Results

Sixty-five respondents from 21 American states completed the survey. The majority of respondents were female, over 65 years of age, and/or had practiced for 30 years or more. The most frequent obstacles encountered with regard to lithium monitoring were adverse drug effects, and the need for monitoring. Overall, respondents believed saliva lithium monitoring and point-of-care devices would be useful, however raised concerns regarding validity and time-delay.

Conclusion

Point-of-care devices and saliva lithium monitoring are promising alternatives to blood testing that would be welcomed by psychiatric societies, however, require extensive development and validation before implementation into a clinical setting.

Keywords:

• lithium
• saliva
• drug monitoring
• point-of-care
• survey

Acknowledgments

This work was supported by the Elisabeth Severance Prentiss Foundation. The sponsor was not involved in study design, collection, analysis or interpretation of data, the writing of the manuscript or the decision to submit the manuscript for publication. We would like to thank Prof. Douglas Granger, Prof. Michael J. McCarthy, Dr. Soe Thein, and Assistant Prof. Kate Kuhlman for providing feedback on study design and survey content.

Disclosure

The authors report no conflicts of interest in this work.