Analysing lithium, quetiapine and valproic acid on social media: an infodemiology study

Abstract Background Although lithium is considered the gold standard for the maintenance treatment of bipolar disorder (BD), its prescription has declined in recent decades. At the same time, second-generation antipsychotics (SGAs), such as quetiapine, and other mood stabilisers such as valproic acid, have been increasingly used. Social media platforms such as X (formerly Twitter) provide real-time insights into public and professional perceptions of these treatments, which may influence their use and adherence. Aims To analyse how lithium, quetiapine, and valproic acid have been represented on X, by focusing on user type, engagement levels, and thematic content of tweets. Method We conducted a mixed-methods, observational study of tweets published in English and Spanish between 2008 and 2022. Tweets containing the generic or commercial names of lithium, valproic acid, and quetiapine were retrieved and analysed using a validated codebook and semi-supervised machine-learning models. Tweets were categorised by user type and clinical and non-clinical content themes. Results Among the 236,797 analysed tweets, quetiapine was the most frequently mentioned drug (69.4%), followed by valproic acid (19.1%) and lithium (11.5%). Lithium tweets showed the highest engagement (54.0 likes and 18.0 retweets per tweet). Patients mainly focused on quetiapine (47.0%), while healthcare professionals more often discussed lithium (58.1%). Tweets containing clinical content were more common in English (78.0%) than in Spanish (54.7%), especially regarding side effects (53.1% vs 8.2%). Tweets on effectiveness were more frequently discussed in English (48.8%), especially for quetiapine (54.7%), but were less common in Spanish (9.8%). Discussion about drug shortages was more prevalent in Spanish tweets (31.6% vs 0.5%), particularly for valproic acid (55.8%). Conclusions Despite lithium being the least mentioned drug, it generated the highest level of engagement, particularly among healthcare professionals. In contrast, quetiapine was widely mentioned by patients, which reflects a more socially widespread and, at times, problematic use. These findings highlight the value of listening to conversations on social media to better understand perceptions, concerns, and attitudes that may influence adherence and prescribing trends in mental health.