Page 24 - Depression in adults: treatment and management

Depression in adults: treatment and management (NG222)

• after the first year, measure plasma lithium levels every 6 months, or every 3 months

for people in any of the following groups:

－ older people

－ people taking medicines that interact with lithium

－ people who are at risk of impaired renal or thyroid function, raised calcium levels
or other complications

－ people who have poor symptom control

－ people with poor adherence

－ people whose last plasma lithium level was 0.8 mmol per litre or higher. [2022] [2022]

1.4.30 Determine the dose of lithium according to response and tolerability:

• plasma lithium levels should not exceed 1.0 mmol/L (therapeutic levels for

augmentation of antidepressant medication are usually at or above 0.4 mmol/L;
consider levels 0.4 to 0.6 mmol/L for older people aged 65 or above)

• do not start repeat prescriptions until lithium levels and renal function are stable

• take into account a person's overall physical health when reviewing test results

(including possible dehydration or infection)

• take into account any changes to concomitant medication (for example, angiotensin-

converting enzyme inhibitors, angiotensin 2 receptor blockers, diuretics and non-
steroidal anti-inflammatory drugs [NSAIDs], or over-the-counter preparations) which
may affect lithium levels, and seek specialist advice if necessary

• monitor at each review for signs of lithium toxicity, including diarrhoea, vomiting,
coarse tremor, ataxia, confusion and convulsions

• seek specialist advice if there is uncertainty about the interpretation of any test
results. [2022] [2022]

1.4.31 Manage lithium prescribing under shared care arrangements. If there are
concerns about toxicity or side effects (for example, in older people or people

with renal impairment), manage their lithium prescribing in conjunction with
specialist secondary care services. [2022] [2022]

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