Lithium (Li) is the cornerstone maintenance treatment for bipolar disorders (BD), but response rates are highly variable. To date, no clinical or biological marker is available to reliably define eligibility criteria for a maintenance treatment with Li. We examined whether the prophylactic response to Li (assessed retrospectively) is associated with distinct blood DNA methylation profiles. Bisulfite-treated total blood DNA samples from individuals with BD type 1 (15 excellent-responders (LiERs) versus 11 non-responders (LinRs)) were used for targeted enrichment of cpG rich genomic regions followed by high-resolution next-generation sequencing to identify differentially methylated regions (DMRs). After controlling for potential confounders we identified 111 DMRs that significantly differ between LiERs and LiNRs with a significant enrichment in neuronal cell components. Logistic regression and receiver operating curves identified a combination of 7 DMRs with a good discriminatory power for response to Li (Area Under the Curve 0.806). Annotated genes associated with these DMRs include Eukaryotic Translation Initiation Factor 2B Subunit Epsilon (EIF2B5), Von Willebrand factor A Domain Containing 5B2 (VWA5B2), Ral GTPase Activating Protein Catalytic Alpha Subunit 1 (RALGAPA1). Although preliminary and deserving replication, these results suggest that biomarkers of response to Li may be identified through peripheral epigenetic measures.An early age at onset, a high rate of mood recurrences, the associated medical health and psychosocial burdens make bipolar disorder (BD) one of the leading causes of disability in the young population 1,2 . Consensus conferences and experts' guidelines recommend lithium (Li) as a first-line prophylactic treatment for BD 3 . Indeed, Li has proven its efficacy for treating acute manic episodes 4 , for preventing mood relapses of any polarity 5,6 , and also for preventing suicidal behaviors 5 .Predicting response to Li in BD is crucial to move towards a more personalized medicine 7 . Indeed, not all patients receiving Li for at least two cumulative years of treatment will display improvement in the frequency and/ or severity of mood recurrences. In individuals with BD who received Li, three subpopulations (full or excellent responders, partial responders and non-responders) have been repeatedly identified, with around one third of the patients belonging to each group [8][9][10] .Considerable research effort has been dedicated to the identification of clinical predictors of a 'good response' to Li, however no definite eligibility criteria for Li treatment has been identified 11 . For example, Hui and colleagues used a meta-analytic approach to suggest six predictors of good response to Li: mania-depression-interval sequence, absence of rapid cycling, absence of psychotic symptoms, family history of bipolar disorder, shorter