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

## TL;DR

This study examines low lithium prescription rates for bipolar disorder at a South African hospital, despite its proven effectiveness.

## Contribution

The study provides new data on lithium use for bipolar disorder in Africa, highlighting a concerning trend.

## Key findings

- Only 6.3% of bipolar disorder patients were prescribed lithium, often in combination with other medications.
- Most patients received oral antipsychotics and anticonvulsants as primary treatments.
- The low lithium use contrasts with its status as a first-line treatment in South African guidelines.

## Abstract

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.

This study aimed to investigate the prescription of lithium for outpatients with BD.

Townhill Hospital, a tertiary pyschiatric hospital in Pietermaritzburg, KwaZulu- Natal.

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.

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.

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.

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.