Guidance on Lithium Therapeutic Ranges in Old Adults with Bipolar Disorder

May 5, 2026

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This document summarizes recent guidance from the International Society of Bipolar Disorder (ISBD) Task Force on Old Adults with Bipolar Disorder (OABD) on reporting of age-specific lithium therapeutic ranges for OABD.

Executive Summary

• Current state-of-the-art lithium therapeutic ranges are inappropriately high for OABD on lithium
• treatment resulting in increased risk for lithium toxicity
• The ISBD Task Force on OABD recommends the following age-specific therapeutic ranges:
  • 0.4 – 0.8 mmol/L for 60 – 79 years old
  • 0.4 – 0.7 mmol/L for >80 years old
• Analytical performance assessments of lithium assays across all major in vitro diagnostic (IVD) platforms confirmed feasibility of broad implementation of the recommended therapeutic ranges.

Authors / contact

Compiled by: Dr. Felix Leung

Project lead: Dr. Lei Fu

Contributors: Dr. Saranya K. Arnoldo, Dr. Sarah Delaney, Dr. Daniel R. Beriault, and Dr. Davor Brinc.