Clinicians' Preferences and Attitudes toward the Use of Lithium in the Treatment of Bipolar Disorders in Mexico.

Abstract

Introduction: Lithium remains a crucial treatment for bipolar disorder, with well-supported effectiveness in stabilizing mood and preventing suicide. A global decline in lithium prescriptions has been observed - often due to safety concerns, demand, and issues with clinician training. In Mexico, recent data on prescribing habits and barriers to lithium use are lacking. This study aimed to assess current trends, challenges, and clinical opinions about lithium among psychiatrists and psychiatry residents.

Methods: A 27-item Spanish questionnaire, adapted from the ISBD Lithium Task Force survey, was distributed electronically through national psychiatric associations and professional networks between April and June 2025. Descriptive and stratified analyses were performed based on practice setting and years of clinical experience, and a multivariable logistic regression identified predictors of frequent lithium avoidance.

Results: A total of 267 clinicians participated in the survey. Lithium was the preferred first-line option for maintenance therapy (46.1%), yet 52.5% of respondents reported avoiding it. During maintenance, 53.8% of clinicians aimed for serum lithium levels between 0.5 and 0.8 mEq/L. For manic episodes, higher targets were common: 65.0% aimed for 0.8-1.0 mEq/L, and 10.9% sought levels above 1.0 mEq/L. Early-career clinicians in public settings reported the greatest structural barriers, such as limited access to serum monitoring and medication shortages. Overall, nearly half faced availability challenges, with medication unavailability being the strongest predictor of lithium avoidance in multivariable models (OR = 3.4). The main barrier was medication unavailability (46.1%), and the most common adherence strategy was patient psychoeducation about lithium's long-term benefits (75.3%), followed by dose adjustments to reduce adverse effects (58.4%).

Conclusion: Mexican clinicians generally support lithium as a key maintenance treatment for bipolar disorder. However, its use is limited by supply issues and infrastructure gaps, especially in the public sector and among early-career practitioners. Ensuring a steady supply of lithium, improving laboratory capacity, and providing practical training could help maintain lithium as an evidence-based, first-line option in Mexico's mental healthcare system.