1 INTRODUCTION

We agree in general with Malhi et al's forthright Editorial “Make Lithium Great Again”, where they reiterate that, despite its clear efficacy and effectiveness, lithium remains under‐utilized in the treatment of bipolar disorder. Possible reasons they give for this include prescription of second generation antipsychotics (SGAs), which may appear easier to prescribe, are marketed better, and may appear to require less monitoring. They also make the most pertinent point about clinical expertise being required for lithium prescribing.¹ We concur with these views and wish to add a UK perspective in addition to how this problem may be tackled‐at least at the psychiatry trainee level.

In the UK, lithium monotherapy is recommended as first line long‐term pharmacological therapy for bipolar disorder by the British Association for Psychopharmacology Guidelines.² Despite this, prescribing of lithium in the UK appears to be decreasing. A recent national (Scottish) linkage study found only 5.90% of patients on long‐term pharmacological therapy for bipolar disorder received lithium monotherapy between 2009 and 2016. Prescription of lithium decreased each year and lithium was the fifth most prescribed medication for bipolar disorder after antidepressant monotherapy, antipsychotic monotherapy, hypnotic/anxiolytics and combined treatment with antidepressants & antipsychotics.³ Most antidepressants have been off patent for a number of years and are not licensed by the European Medicines Agency (EMA) as treatments for bipolar disorder. They are thus unlikely to have been significantly marketed by pharmaceutical companies for this (non)indication. Furthermore, concerns regarding under‐use of lithium predate the rise of SGAs for treatment of bipolar disorder. Ronald Fieve raised concerns regarding decreased lithium prescription in 1999.⁴ This was prior to any SGAs gaining EMA approval for bipolar disorder. At that time there were concerns regarding marketing and promotion of antiepileptic medications, in a similar manner to how Malhi et al comment on SGAs.

中文翻译：

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回到基础-英国关于“再造锂电池”的观点Malhi等人

1引言

我们总体上同意Malhi等人的直截了当的社论“使锂再次变得伟大”，他们在其中重申，尽管锂具有明显的功效和功效，但在双相情感障碍的治疗中仍未得到充分利用。他们为此提供的可能原因包括第二代抗精神病药（SGA）的处方，这种处方似乎更容易开处方，市场销售较好，并且似乎需要较少的监测。他们还提出了锂处方所需的临床专业知识的最相关要点。¹我们同意这些观点，并希望在解决问题的方法之外，至少在精神病学见习人员级别上，添加英国的观点。

在英国，《英国精神药物协会指南》建议将锂单一疗法作为双相情感障碍的一线长期药物疗法。²尽管如此，英国的锂处方似乎正在减少。一项最近的国家（苏格兰）联系研究发现，在2009年至2016年之间，仅接受双相情感障碍长期药物治疗的患者中有5.90％接受了锂单药治疗。锂的处方每年都在减少，并且锂是抗抑郁药之后治疗双相情感障碍的第五个处方药单一疗法，抗精神病药物单一疗法，催眠/抗焦虑药以及抗抑郁药和抗精神病药的联合治疗。³大多数抗抑郁药已获得专利多年，并且未获得欧洲药品管理局（EMA）的许可用于双相情感障碍的治疗。因此，对于该（非）适应症，它们不太可能被制药公司大量销售。此外，对锂使用不足的担忧早于用于治疗躁郁症的SGA的兴起。Ronald Fieve在1999年提出了有关减少锂处方的担忧^。4这是在任何SGA获得双相情感障碍EMA批准之前的。当时，人们对抗癫痫药物的营销和推广存在担忧，其方式与Malhi等人对SGA的评论类似。