# Safer Lithium Monitoring Needed for Older Adults with Bipolar Disorder
Lithium has been a cornerstone treatment for bipolar disorder for decades, helping to stabilize mood and prevent episodes of mania and depression. However, this medication requires careful monitoring through blood tests because the difference between an effective dose and a toxic dose can be narrow—especially in older adults. As people age, changes in kidney function, body composition, and how medications are processed can make them more vulnerable to lithium toxicity, which can cause serious side effects including confusion, tremors, and kidney damage.
A group of psychiatric specialists in the UK has raised important concerns that current national guidelines may not provide adequate safety guidance for monitoring lithium levels in older people. The existing NICE (National Institute for Health and Care Excellence) guideline for bipolar disorder uses the same recommended blood level ranges for all adults, regardless of age. However, the authors argue that older adults need lower target ranges to reduce the risk of toxicity while still maintaining the medication’s effectiveness. They recommend that UK laboratories adopt the more age-appropriate guidance from the International Society for Bipolar Disorder, which recognizes the unique vulnerabilities of older patients.
This call for updated monitoring standards has important implications for the many older adults who rely on lithium to manage their bipolar disorder. Lower recommended ranges would provide an additional margin of safety, potentially preventing hospitalizations and serious complications from lithium toxicity. For families and caregivers, this means being aware that older loved ones on lithium may benefit from more conservative dosing approaches. Healthcare providers, particularly those in primary care who often oversee lithium monitoring, should be alert to the fact that older patients may need different target levels than younger adults. While waiting for official guideline changes, clinicians can already discuss with their older patients whether adjusting their lithium levels within a lower, safer range might be appropriate for their individual circumstances.
Source Information
Original Title: The importance of safe lithium plasma monitoring in older people.
Authors: Rubinsztein JS, Willis S, Birgi H, Sachdev K, Southwell C
Journal: BJPsych bulletin (Oct 2025)
PubMed ID: 41126762
This summary was generated using AI to make recent geriatrics and frailty research more accessible. Please refer to the original article for complete details.
