ABSTRACT
When lithium was discovered by Cade in 1949 as a treatment of mania (‘excited psychosis’), three elderly subjects among the ten manic patients treated with lithium responded well to lithium citrate1, although all three developed side-effects. In two, dose adjustment reduced the side-effects and lithium remained effective. In the third patient the side-effects mandated discontinuation of the treatment. Today, these cases still illustrate the key issues of administering lithium in the elderly: its efficacy in this age group, the need for dose adjustments and sensitivity to side-effects. Treatment of bipolar disorder in the elderly is not based on strong scientific evidence but rather on open-label prospective or retrospective studies2. Interestingly, although lithium has been the treatment of choice for bipolar disorder, its efficacy as an augmenting agent in the treatment of unipolar depression has been studied more rigorously in this age group. The discovery that lithium may have neuroprotective potential3-5 has reinvigorated interest in the biology of lithium and its use in geriatric patients.
