Updated perspectives on how and when lithium should be used in the treatment of mood disorders

ABSTRACT

Introduction

Lithium is one of the most important drugs for the treatment of mood disorders. The appropriate guidelines can ensure that more patients benefit from its use in a personalized way.

Areas covered

This manuscript provides an update on the application of lithium in mood disorders, including prophylaxis of bipolar and unipolar mood disorder, treatment of acute manic and depressive episodes, augmentation of antidepressants in treatment-resistant depression, and use of lithium in pregnancy and the postpartum period.

Expert opinion

Lithium remains the gold standard for the prevention of recurrences in bipolar mood disorder. For long-term treatment/management of bipolar mood disorder, clinicians should also consider lithium’s anti-suicidal effect. Furthermore, after prophylactic treatment, lithium may also be augmented with antidepressants in treatment-resistant depression. There have also been some demonstration of lithium having some efficacy in acute episodes of mania and bipolar depression as well as in the prophylaxis of unipolar depression.

KEYWORDS:

• Lithium
• bipolar disorder
• mania
• augmentation of antidepressants
• recurrent depression
• pregnancy
• postpartum

Article highlights

• The main indication for long-term lithium administration is the prevention of manic and depressive recurrences in mood disorders.

• The adverse side effects and interactions of long-term lithium treatment can be manageable.

• Long-term lithium treatment involves some beneficial side effects - such as anti-suicidal, antiviral, and neuroprotective.

• The augmentation of antidepressants in treatment-resistant depression can make the second indication for using lithium.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose

Additional information

Funding

This manuscript has not been funded.