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No study has investigated when preventive treatment with lithium should
be initiated in bipolar disorder.
To compare response rates among patients with bipolar disorder starting
treatment with lithium early v. late.
Nationwide registers were used to identify all patients with a diagnosis
of bipolar disorder in psychiatric hospital settings who were prescribed
lithium during the period 1995–2012 in Denmark (n =
4714). Lithium responders were defined as patients who, following a
stabilisation lithium start-up period of 6 months, continued lithium
monotherapy without being admitted to hospital. Early v.
late intervention was defined in two ways: (a) start of lithium following
first contact; and (b) start of lithium following a diagnosis of a single
Regardless of the definition used, patients who started lithium early had
significantly decreased rates of nonresponse to lithium compared with the
rate for patients starting lithium later (adjusted analyses: first
v. later contact: P<0.0001;
hazard ratio (HR) = 0.87, 95% CI 0.76–0.91; single manic/mixed episode
v. bipolar disorder: P<0.0001; HR
= 0.75, 95% CI 0.67–0.84).
Starting lithium treatment early following first psychiatric contact or a
single manic/mixed episode is associated with increased probability of
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