Clinically relevant treatment considerations regarding lithium use in bipolar disorder

ABSTRACT

Introduction: The goal of this paper is to provide a practical, clinically oriented review of lithium, a salt widely used to treat mania since the 1870s and formally approved as a mood stabilizer in 1970. Although lithium is still considered a first-line treatment for bipolar mania in most practice guidelines, its use may be overshadowed by newer psychotropic medications.

Areas covered: This paper addresses the historical use of lithium, modern indications for its use, guidelines for prescribing and monitoring continued lithium use, drug-drug interactions, and pharmacodynamics/pharmacokinetic properties. The paper also reviews the unique properties of lithium and their potential clinical importance.

Expert opinion: While the use of lithium does involve some unique risks to the patient, it may also has some unique advantages in certain patient populations. Two major findings that make lithium unique are its potential neuroprotective benefits and decreased risk of suicide in patients with mood disorders.

KEYWORDS:

• Lithium
• mood stabilizer
• bipolar disorder
• mania
• bipolar depression
• drug-drug interactions
• pharmacodynamics
• pharmacokinetics

Article highlights

• Lithium is widely used to treat acute bipolar mania, bipolar depression, and prevent mood episodes associated with bipolar disorder.

• Lithium is commonly used as an augmentation strategy for treatment-resistant unipolar depression and has been shown to significantly reduce the risk of suicide in patients with mood disorders.

• Lithium prescribing requires awareness of drug-drug interactions, regular monitoring of the lithium level, and knowledge of factors that affect clearance.

• Lithium is believed to have neuroprotective effects with the ability to slow or even stop neuronal loss, which may also benefit patients with cognitive disorders.

• Lithium may be underutilized given its proven clinical effectiveness and unique properties.

This box summarizes key points contained in the article.

Declaration of interest

M Macaluso has conducted clinical trials research as principal investigator for the following pharmaceutical companies over the last 12 months Acadia, Alkermes, Allergan, AssureRx, Eisai, Lundbeck, Janssen, Naurex/Aptinyx, Neurin. All clinical trial and study contracts were with payments made to the Kansas University Medical Cancer Research Institute, a research institute affiliated with Kansas University School of Medicine Wichita (KUSM-W). The authors have no other 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 apart from those disclosed.

Additional information

Funding

This paper was not funded.