The study, published in European Psychiatry, was led by Vincenzo Oliva and Michele De Prisco, researchers from the IDIBAPS group Bipolar and Depressive Disorders, with the participation of Eduard Vieta, head of the Psychiatry and Psychology Service at Clínic Barcelona and the IDIBAPS group, and Diego Hidalgo-Mazzei as senior authors of the studies.
Bipolar disorder (BD) is a severe mental disorder that affects approximately 1% of the global population. It is characterised by extreme mood shifts, ranging from manic episodes to deep depressions. In addition to its impact on quality of life, BD is associated with a high risk of mortality, both from natural causes (such as cardiovascular diseases) and non‑natural causes (such as suicide).
Assessing the impact of lithium on survival
The study analysed the medical records of more than 15,000 people with bipolar disorder in Catalonia between 2010 and 2019. These data were drawn from the population cohort PADRIS-PRESTO, developed by Clínic‑IDIBAPS in collaboration with the Agency for Health Quality and Assessment of Catalonia (AQuAS). The objective was to determine whether different patterns of lithium intake —continuous, intermittent or none—were associated with differences in all‑cause mortality.
Patients who consistently took lithium had a significantly lower mortality risk compared with those who did not take it or took it intermittently. The mortality rate was 5.87 deaths per 1,000 person‑years in the continuous‑use group, compared with 10.5 in the intermittent group and 10.9 in the non‑exposed group. Moreover, this protective effect remained even at lower doses, as long as the medication was taken continuously.
The study also observed that this protective effect is independent of the presence of physical comorbidities, reinforcing the importance of maintaining long‑term treatment.
Importance of treatment adherence
This study highlights the relevance of maintaining continuous lithium treatment to maximise its survival benefits. While intermittent use does not offer the same level of protection—and may even be counterproductive—continuous intake provides a significant survival benefit.
The authors emphasise the value of clinical approaches that support adherence while also addressing other physical health conditions, which remain a key predictor of mortality.
Study reference
Oliva V, De Prisco M, Anmella G, Valenzuela-Pascual C, Mas A, Fernández T, Fico G, Murru A, Valentí M, Blanch J, Radua J, Young AH, Vieta E, Hidalgo-Mazzei D. Patterns of lithium exposure and mortality in bipolar disorder: A population-based cohort study. European Psychiatry. 2025; 68(1): e129. https://doi.org/10.1192/j.eurpsy.2025.10090
