When and how to use lithium

Abstract

Background Lithium is an old proven medication, but it is infrequently used in current practice. This review examines evidence for its benefits and risks and provides clinical guidance to its use. Method Narrative review. Results Besides its benefit in bipolar illness, lithium has important underappreciated proven benefits in prevention of unipolar depression and suicide. Emerging data support neurobiological benefits for cognition and possible dementia prevention. Likely benefits also exist in low doses for mood temperaments (cyclothymia and hyperthymia). High doses (over 1.0 mmol/L) should be avoided since they increase side effects, complications associated with long‐term use, and risk of toxicity. Conversely, low dosing can be legitimate, especially for suicide and dementia prevention. Nuisance side effects of lithium may affect adherence, and medically serious side‐effects can occur. Managing strategies are available for side effects. Conclusion Lithium is the most effective medication in psychiatry, because it has disease‐modifying, not just symptomatic, effects. It is effective not only for bipolar illness but also for prevention of suicide, episodes of unipolar depression, mood temperaments, and possibly dementia. Its many benefits need better appreciation, while lowered dosing can reduce risks.

Trajectories of suicidal ideation after first‐episode psychosis: a growth mixture modeling approach

“…In this second group, therapies focused on managing SI and improving functional outcomes may be needed additionally to symptomatic treatment 77 . Furthermore, this subgroup may also benefit from psychopharmacological therapies with evidence of specific antisuicidal effects, such as lithium or clozapine 78‐80 . Long‐acting antipsychotics might also prove beneficial in reducing suicidal risk already in these early stages.…”

“…77 Furthermore, this subgroup may also benefit from psychopharmacological therapies with evidence of specific antisuicidal effects, such as lithium or clozapine. [78][79][80] Longacting antipsychotics might also prove beneficial in reducing suicidal risk already in these early stages. In addition to improving adherence, which can lead to better clinical and functional outcomes, treatment administration involves a frequent contact with mental health services.…”

Prediction of individuals at high-risk of chronic kidney disease during treatment with lithium for bipolar disorder

“…Lithium is the most effective maintenance treatment for bipolar disorder, and is first-line in all international clinical practice guidelines (1). However, its use has been declining globally (2).…”

Lithium: about discrepancies between efficacy and clinical use

“…In this issue of Acta Psychiatrica Scandinavica, two narrative reviews deal with important treatment areas of bipolar disorder. The paper by Barroilhet and Ghaemi (2) focuses exclusively on the role of lithium, while Pacchiarotti and colleagues (3) review more broader treatment concepts of mania including the position of lithium. Both reviews are timely documents by providing evidence, practical guide for clinicians, and some general clues specifically related to lithium.…”

“…From a historical perspective, more than 70 years from the breakthrough of identifying lithium salts to have antimanic activity, modern research serves to further substantiate lithium’s position at the front‐line in the treatment of bipolar disorder. Undoubtedly, lithium is an essential medication for patients with mood disorders and represents the most valuable treatment option in the long‐term treatment of bipolar disorders, and also likely to unipolar major depressive disorder – the latter indication is considered by Barroilhet and Ghaemi (2) an important but often forgotten or neglected fact. Since its introduction in modern psychiatry in 1949, many new aspects of its use in psychiatry have been discovered in basic and clinical research, including anti‐suicidal and antidepressant properties.…”