No correlation between lithium serum levels and psychopathological features during the euthymic interval of patients with recurrent affective disorder

Pharmacopsychiatry. 2012 Jan;45(1):1-6. doi: 10.1055/s-0031-1286343. Epub 2011 Oct 11.


Introduction: The aim of this prospective study was to investigate the influence of lithium serum levels on subclinical psychopathological features during the euthymic interval in patients with an affective disorder.

Methods: The study included 54 patients with a recurrent affective disorder undergoing a continuous prophylactic lithium treatment (31 unipolar, 23 bipolar). The observation period lasted for 2 years and included 332 visits. Visits consisted of a detailed interview, a continuous measurement of lithium levels and the collection of validated scales including HAMD, YMRS, CGI, VAMS and the SCL-90R. Several correlations between lithium serum levels and different psychopathological features during the euthymic interval were calculated on an individual patient basis and on a group basis to reveal generally occurring correlations.

Results: No generally occurring significant correlations between lithium serum levels and specific psychopathological features were found. Only on a single patient level, 32 significant correlations between lithium level and specific psychopathological features were found, partly indicating a negative and partly indicating a positive influence of higher lithium levels on psychopathological symptoms. Nevertheless, in the group analyses no significant correlations were found.

Discussion: Higher lithium levels were not associated with an improved psychopathological status, but they were not associated with a worse status (due to a higher burden of side effects) either. According to the literature there is currently no strong evidence to treat patients with a higher lithium level. It is recommended to start with a lower level and to continue with individual adjustments in accordance to prophylactic efficacy and tolerability.

MeSH terms

  • Adult
  • Affect / drug effects
  • Affective Disorders, Psychotic / blood*
  • Affective Disorders, Psychotic / physiopathology
  • Affective Disorders, Psychotic / prevention & control
  • Affective Disorders, Psychotic / psychology*
  • Aged
  • Antimanic Agents / adverse effects
  • Antimanic Agents / pharmacokinetics
  • Antimanic Agents / therapeutic use*
  • Drug Monitoring*
  • Female
  • Germany
  • Hospitals, University
  • Humans
  • Lithium / blood*
  • Lithium Chloride / adverse effects
  • Lithium Chloride / pharmacokinetics
  • Lithium Chloride / therapeutic use*
  • Male
  • Medical Records
  • Middle Aged
  • Outpatient Clinics, Hospital
  • Prospective Studies
  • Psychiatric Status Rating Scales
  • Secondary Prevention
  • Young Adult


  • Antimanic Agents
  • Lithium
  • Lithium Chloride