do fewer than 20% of us bipolar patients get lithium, versus over half elsewhere?

“in the US, like less than 20% gets lithium, whereas in the rest of the world, more than half of the bipolar patients get lithium.”

a guest, a psychiatrist and director of a women's mental health center said on Psychiatry & Psychotherapy Podcast, 2026-09-18, at 31:11. hear it in context →

the episode: Postpartum Psychosis: Diagnosis, Treatment, Lithium, and Relapse Prevention with Dr. Veerle Bergink (at 31:11). we link the show's own page; we do not re-host audio.

first, the part that holds

The US half of this checks out. US office-visit data show lithium in roughly 14 to 17% of bipolar care since the late 2000s, and US use does trail Europe's and Asia's.

what we found when we went and looked

For the US, a national survey of office-based practice found lithium recorded for 38.1% of bipolar patients in 1996-97, falling to 14.3% by 2006-07 and "stable since." A 2024 review of 55 studies put North America at 17.1% after 2010. The "more than half elsewhere" part doesn't hold up as a general statement. The same review averaged 35.7% for Europe and 26.2% for Asia. A 2024 review by a lithium researcher put use internationally at "approximately 35% ever use or less." The only figure over 50% we found was the average across counties in a Swedish specialist-care registry (52.4%). So the gap is real, but it is closer to 17% versus about 30-36% than to 20% versus more than half.

assertion by assertion

both directions

for the speaker: The US number holds up well. Lin and colleagues' national survey data put lithium at 14.3% of US office-based bipolar care from 2006-07 onward, and the scoping review's North American average after 2010 is 17.1%. Both are under the speaker's 20%. US use is also lower than the European and Asian averages. Some non-US settings do exceed half: Swedish specialist registry patients average 52.4% (up to 84.9% in some counties), and most surveyed Spanish psychiatrists say they put more than half of their bipolar patients on lithium. A clinician who has worked in or with those systems could reasonably come away with the speaker's picture.

against: "The rest of the world" covers a lot of places, and the averages there are well under half: Europe 35.7% and Asia 26.2% in the 2024 scoping review. A 2024 review by a lithium researcher describes use internationally as declining "to approximately 35% ever use or less." Consumption-based coverage across 11 European countries runs from 5.3% (Estonia, Croatia) to 32.6% (Sweden). Even within Europe, Scotland (22%) and Germany (26.2%) sit close to the US figure. The speaker's contrast roughly doubles the gap that the data actually show.

what this cannot say

The studies measure different things, so none of these numbers line up exactly. US figures count weighted office visits, not every person with bipolar disorder, and the national series ends around 2016. The scoping review averages studies that differ in method, setting and years. The Swedish registry covers specialist-treated patients, the European coverage estimate comes from drug-sales data set against assumed prevalence, and the Spanish figures are what psychiatrists reported about themselves. Most of the world, including Africa, Latin America and much of Asia, has little or no published data, so no source can really speak for "the rest of the world." We read abstracts through the PubMed database, not full texts; the scoping review's per-study tables would not load. The speaker named no source, so we cannot tell which study they had in mind.

sources, each one fetched and read

1. Lin Y, Mojtabai R, Goes FS, Zandi PP. Trends in prescriptions of lithium and other medications for patients with bipolar disorder in office-based practices in the United States: 1996-2015. Journal of Affective Disorders, 2020. PMID 32739706 What we read there: Reported use of lithium declined from 38.1% (95%CI: 29.8% - 46.3%) in 1996-97 to 14.3% (95%CI: 10.6% - 18.1%) in 2006-07 and has remained stable since. Fetched 2026-10-23 (HTTP 203). https://pubmed.ncbi.nlm.nih.gov/32312111/
2. Sköld M, et al. Regional lithium prescription rates and recurrence in bipolar disorder. International Journal of Bipolar Disorders, 2021;9(1):18. PMID 34061259, doi:10.1186/s40345-021-00223-7 What we read there: Swedish BipoläR registry, 14,616 patients: lithium prescription rates across 21 counties ranged from 37.7 to 84.9% (mean 52.4%). Fetched 2026-10-23 (HTTP 203). https://pubmed.ncbi.nlm.nih.gov/34061259/
3. Survey of 212 psychiatrists in Spain on lithium use in bipolar disorder. International Journal of Bipolar Disorders, 2021. PMC7941362 What we read there: 70% of psychiatrists prescribe lithium to more than 50% of patients diagnosed with BD; the paper contrasts this with reported rates in Germany (26.2%), Scotland (22%) and the US (17.6%). Fetched 2026-10-23 (HTTP 200). https://pmc.ncbi.nlm.nih.gov/articles/PMC7941362

speakers are described by role, not named. one sentence is quoted under fair use, with attribution and a link to the original at the timestamp; we do not re-host audio or video. nothing on this page is a reason to start, stop or change a medication. if you have the file behind anything marked unverifiable, the research board is where people can answer. adam