Safe lithium prescribing: initiation and monitoring

by Dr Ekta SharmaDr Tayeem Pathan and Dr Dhanya Shinith


Last reviewed: March 2021


Lithium is one of the oldest mood stabilisers prescribed in psychiatry, and is among the most efficacious treatments for bipolar affective disorder and treatment-resistant depression. However, it is well known that patients on lithium commonly suffer from adverse effects.


Many of these side-effects are preventable by improving clinical practice. Despite this, audits carried out by the Prescribing Observatory for Mental Health (POMH-UK) have shown that a significant number of patients are not monitored in accordance with NICE guidance. The National Patient Safety Agency (NPSA) received 567 incident reports relating to lithium use from 2003–2008, and the NHS litigation authority dealt with two fatal and twelve severe harm incidents involving lithium therapy from 1995–2004.


We hope that this module will not only help you learn about lithium but will also help you understand the need for keeping patients informed, as well as for regular monitoring and timely management of side-effects.


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