Compliance with the safety guidelines for long-term lithium treatment in Sweden

J Psychopharmacol. 2018 Oct;32(10):1104-1109. doi: 10.1177/0269881118780014. Epub 2018 Jun 13.


Background: Lithium has been used for more than 50 years and guidelines for treatment monitoring have been documented in Sweden since the beginning of the 1980s.

Aims: The aim of this study was to describe compliance over time with the Swedish guidelines for long-term lithium treatment.

Methods: The study material was obtained from Sahlgrenska University Hospital's laboratory database. We analysed data (serum lithium and serum creatinine) of adult patients treated with lithium between 1981 and 2010, and determined compliance with guidelines and serum lithium levels over time.

Results: Our study material included 2841 patients and 25,300 treatment-years. The compliance with guidelines' recommendations regarding lithium and creatinine monitoring increased from 36% in 1981 to 68% in 2010. Women were on average 2% more compliant than men ( p < 0.01). Most lithium samples (87-94%) were within recommended intervals throughout the study period. The average lithium level decreased from 0.70 mmol/L in 1981 to 0.58 mmol/L in 2001, and remained stable thereafter.

Conclusions: Compliance with lithium monitoring guidelines improved slowly but steadily over time. It took three decades to reach a compliance rate of just below 70%. Gender differences were small, but with a significantly better compliance rate for women. Serum lithium was kept within the recommended target interval to a large extent, throughout the study period.

Keywords: Lithium; compliance; creatinine; gender; guidelines.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Antimanic Agents / administration & dosage*
  • Antimanic Agents / adverse effects
  • Antimanic Agents / pharmacokinetics
  • Creatinine / blood
  • Databases, Factual
  • Drug Monitoring / methods
  • Female
  • Guideline Adherence / statistics & numerical data*
  • Hospitals, University
  • Humans
  • Lithium Compounds / administration & dosage*
  • Lithium Compounds / adverse effects
  • Lithium Compounds / pharmacokinetics
  • Longitudinal Studies
  • Male
  • Middle Aged
  • Practice Guidelines as Topic*
  • Retrospective Studies
  • Sex Factors
  • Sweden
  • Time Factors
  • Young Adult


  • Antimanic Agents
  • Lithium Compounds
  • Creatinine