Treatment of Bipolar Disorder in a Lifetime Perspective: Is Lithium Still the Best Choice?

Abstract

Lithium preparations have been successfully used to treat bipolar disorder (BD), and remain the best established long-term treatment for the disorder. In fact, lithium is a cornerstone of treatment to minimize the risk of recurrences and improve inter-episodic symptomatology. We reviewed the available evidence for the use of lithium in the treatment of BD, including its efficacy, limitations, and potential benefits also in consideration of the different formulations available. We also overviewed salient comparative aspects regarding the long-term alternative use of anticonvulsants, antidepressants, and antipsychotics in BD patients. The available evidence indicates that BD patients should be treated primarily with lithium, combined in some cases with antipsychotics especially in acute treatments, and sometimes, because of intolerance or inefficacy of lithium, with anticonvulsants. The use of adjunctive antidepressants should be limited to episodes of breakthrough depression. Lithium should be offered to the majority of BD patients as initial treatment especially when suicide ideation or behavior is present with adequate information about its long-term benefits and its potential side effects. Many patients can tolerate lithium without concomitant use of antidepressants, which may worsen the course of the illness or antipsychotics, which may cause severe long-term side effects.

<p>Factors Associated with Non-Remission in Bipolar Disorder: The Multicenter Treatment Survey for Bipolar Disorder in Psychiatric Outpatient Clinics (MUSUBI)</p>

“…2 This reflects the notion that the effectiveness of lithium is well established as an initial treatment that usually continues to the maintenance phase of the illness in bipolar disorder. 25 Further, lithium may be effective for patients with mixed state although the evidence is currently insufficient. 26 Although 41.7% of mixed state patients were treated with lithium in this study, there might have been in more remission cases should more patients would have been treated with lithium.…”

Animal models for bipolar disorder: from bedside to the cage

“…Nevertheless, our current knowledge in the 21st century about the disorder is still limited. Given the fact that lithium, one of the top choice treatment options (Sani et al 2017), was discovered by animal research (Cade 1949), animal models for the disorder can be a very useful tool to advance our knowledge. Indeed, several models have either confirmed findings from patients or even extended these findings by explaining the underlying neurobiological mechanisms.…”

Compliance with the guidelines for laboratory monitoring of patients treated with lithium: A retrospective follow‐up study among ambulatory patients in the Netherlands

“…Lithium is approved for the acute treatment of mania and prophylaxis of bipolar disorder and is additionally used to augment antidepressant therapy in unipolar depression . Monitoring of lithium serum levels is important to prevent harm and to improve effectiveness among its users.…”

“…Thyroid function may decline, with a risk of developing goiter. Based on these risks, monitoring of lithium serum levels, renal and thyroid function is important …”