Lithium (Li
+) is widely used to treat bipolar disorder (BPD). Cellular targets of Li + , such as glycogen synthase kinase 3β (GSK3β) and G proteins, have long been implicated in BPD etiology; however, recent genetic studies link BPD to other proteins, particularly ion channels. Li + affects neuronal excitability, but the underlying mechanisms and the relevance to putative BPD targets are unknown. We discovered a dual regulation of G protein-gated K + (GIRK) channels by Li + , and identified the underlying molecular mechanisms. In hippocampal neurons, therapeutic doses of Li + (1-2 mM) increased GIRK basal current (I basal ) but attenuated neurotransmitter-evoked GIRK currents (I evoked ) mediated by G i/o -coupled G-protein-coupled receptors (GPCRs). Molecular mechanisms of these regulations were studied with heterologously expressed GIRK1/2. In excised membrane patches, Li + increased I basal but reduced GPCR-induced GIRK currents. Both regulations were membrane-delimited and G protein-dependent, requiring both Gα and Gβγ subunits. Li + did not impair direct activation of GIRK channels by Gβγ, suggesting that inhibition of I evoked results from an action of Li + on Gα, probably through inhibition of GTP-GDP exchange. In direct binding studies, Li + promoted GPCR-independent dissociation of Gα i GDP from Gβγ by a Mg 2+ -independent mechanism. This previously unknown Li + action on G proteins explains the second effect of Li + , the enhancement of GIRK's I basal . The dual effect of Li + on GIRK may profoundly regulate the inhibitory effects of neurotransmitters acting via GIRK channels. Our findings link between Li + , neuronal excitability, and both cellular and genetic targets of BPD: GPCRs, G proteins, and ion channels.is a common disease of poorly understood molecular mechanisms comprising both neurodevelopmental and genetic factors (1, 2). Lithium (Li + ) stabilizes the condition in many BPD patients. Historically, the etiology of BPD has been linked to cellular targets of Li + , including G proteins, enzymes of phosphoinositide (PI) turnover, and Akt/GSK3β cascade (3-5). However, recent genetic studies have identified a multitude of BPD-associated genes, with a preponderance of proteins related to G-protein-coupled receptors (GPCRs) and ion channels (6), particularly Ca 2+ channels (2, 7, 8). Linkages with ion channel genes extend to other major psychiatric diseases as well, especially schizophrenia (9, 10). To date, no substantial links between BPD and genes of PI turnover enzymes and GSK3β have been identified.To understand BPD, it is important to bridge the gap between protein targets of BPD suggested by genetic vs. cellular studies, and to understand how ion channels are involved. Li + may provide a clue. Li + has neuroprotective and neurotrophic effects (11) and affects neuronal excitability (12, 13) by largely unknown mechanisms. Li + acts intracellularly (14), entering neurons through several nonspecific cation channels and voltage-dependent Na + channels (15). Therapeutic doses of Li + are 0.6-1.2...