Lithium Dispensing Patterns in Dutch Youth: Prevalence, Incidence Dosages, and Duration of Use From 2011 to 2022

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Abstract
Objective: Bipolar disorder (BD) often emerges during mid‐adolescence and young adulthood, and leads to functional and social impairment, with a prevalence of 0.87% among Dutch youth. Lithium, the first‐line BD maintenance treatment, stabilizes mood, prevents suicide, and is well tolerated, yet its use has declined as long‐term second‐generation antipsychotics (SGAs) prescriptions increased. This study explores the prevalence, incidence, duration, prior and concurrent use of psychotropic medications, and dosage patterns of lithium dispensing in Dutch youth. Method: A retrospective cohort study using the Dutch community pharmacy‐based IADB.nl database included 567 youths (6–25 years), who were dispensed lithium between 2011 and 2022. Results: The yearly prevalence of lithium dispensing per 100,000 fluctuated between 30.3 in 2011 and 34.8 in 2022 ( p = 0.40), with the lowest prevalence in 6–12‐year‐olds and highest in 20–25‐year‐olds. Females had overall higher prevalence rates than males ( p = 0.03). Overall incidence rose from 7.9 to 9.3 ( p = 0.68). In 2011, incidence was 10.7 for both the 13–19 and 20–25 age groups. By 2022, this decreased to 4.2 in 13–19‐year‐olds and increased to 19.0 in 20–25‐year‐olds. Approximately 55% of individuals received other psychotropics before lithium, and 52% concurrently, with SGAs and antidepressants being most commonly dispensed. Conclusion: Despite lithium's efficacy and status as first‐line BD maintenance treatment, its dispensing in Dutch youth remains low compared to the BD prevalence. This may be due to misdiagnosis of BD and/or clinicians' reluctance to prescribe lithium, highlighting the need for improved diagnostics, clinician education, and further research into lithium's safety in youths.
Funding Information
  • Erasmus Medisch Centrum
  • ZonMw

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