Use of Lithium in Bipolar Disorder is Shockingly Low: The Need for a Re-evaluation

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Robert M. Post, MD


Bipolar disorder often starts on childhood or adolescence but is too often poorly recognized and treated leading to the evolution of an illness with considerable disability.  While lithium is widely recognized a first line treatment option its use is declining in comparison to other less effective agents.  Here we review the major assets of lithium a drug that can prevent many aspects of illness progression as a function of increased numbers of episodes experienced.  More episodes are related to faster and more severe recurrences cognitive deficits, and treatment refractoriness. Many of the side effects of lithium, such as renal dysfunction, are based on earlier and uncontrolled literature and are over emphasized. Given lithium's unique therapeutic profile, a re-evaluation of its under-utilization is definitely indicated.

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POST, Robert M.. Use of Lithium in Bipolar Disorder is Shockingly Low: The Need for a Re-evaluation. Medical Research Archives, [S.l.], v. 12, n. 4, apr. 2024. ISSN 2375-1924. Available at: <>. Date accessed: 27 may 2024. doi:
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Bellivier, F., Etain, B., Malafosse, A., Henry, C., Kahn, J. P., Elgrabli-Wajsbrot, O., Jamain, S., Azorin, J. M., Frank, E., Scott, J., Grochocinski, V., Kupfer, D. J., Golmard, J. L.Leboyer, M., 2011. Age at onset in bipolar I affective disorder in the USA and Europe. World J Biol Psychiatry.
Bortolozzi A. New Advances in the Pharmacology and Toxicology of Lithium: A neurobiologically-ori-ented overview. Pharmrev Fast Forward. Published on 8 February 2024 as Doi: 10.1124/pharmrev.120.000007
Carvalho AF et al (2024) Mortality and Lithium-Pro¬tective Effects after First-Episode Mania Diagnosis in Bipolar Disorder: A Nationwide Retrospective Cohort Study in Taiwan. Psychother Psychosom. DOI: 10.1159/000535777. P 1-10.
Etain, B., Lajnef, M., Bellivier, F., Mathieu, F., Raust, A., Cochet, B., Gard, S., M'Bailara, K., Kahn, J. P., Elgrabli, O., Cohen, R., Jamain, S., Vieta, E., Le-boyer, M.Henry, C., 2012. Clinical expression of bi¬polar disorder type I as a function of age and po¬larity at onset: convergent findings in samples from France and the United States. J Clin Psychiatry. 73, e561-566.
Geller B, Tillman R, Bolhofner K, Zimerman B (2010). Pharmacological and non-drug treatment of child bipolar I disorder during prospective eight-year follow-up. Bipolar Disord 12: 164–171. [PMC free article] [PubMed] [Google Scholar]
Danella M Hafeman et al. (2020) Lithium Versus Other Mood-Stabilizing Medications in a Longitudi¬nal Study of Youth Diagnosed With Bipolar Disor¬der. J Am Acad Child Adolesc Psychiatry 2020 Oct;59(10):1146-1155. doi: 10.1016/j.jaac.2019.06.013.Epub 2019 Jul 29.
Kessing LV, Hansen HV, Hvenegaard A, Christensen EM, Dam H, Gluud C et al (2013). Treatment in a specialised out-patient mood disorder clinic v. standard out-patient treatment in the early course of bipolar disorder: randomised clinical trial. Br J Psychiatry 202: 212–219. [PubMed] [Google Scholar]
LV Kessing. Lithium as the drug of choice for mainte¬nance treatment in bipolar disorder. Acta Psychiatrica Scandinavica; Volume 140, Issue 2 p. 91-93. First published: 16 July 2019
Kessing LV, Andersen PK (2017). Evidence for clini-cal progression of unipolar and bipolar disorders. Acta Psychiatr Scand 135: 51–64.
Merikangas KR, He JP, Burstein M, Swanson SA, Avenevoli S, Cui L et al (2010). Lifetime prevalence of mental disorders in U.S. adolescents: results from the National Comorbidity Survey Replication—Adolescent Supplement (NCS-A). J Am Acad Child Adolesc Psychiatry 49: 980–989.
Post RM (2016). Epigenetic basis of sensitization to stress, affective episodes, and stimulants: implications for illness progression and prevention. Bipolar Disord 18: 315–324.
Post RM. The New News about Lithium: An Underutilized Treatment in the United States. Neu-ropsychopharmacology. 2018 Apr; 43(5): 1174–1179.
Published online 2017 Nov 8. Prepublished online 2017 Oct 4. doi: 10.1038/npp.2017.238 PMCID: PMC5854802; PMID: 28976944
Post RM, Altshuler LL, Kupka R, McElroy SL, Frye MA, Rowe M et al (2017). More childhood onset bipolar disorder in the United States than Canada or Eu¬rope: implications for treatment and prevention. Neurosci Biobehav Rev 74(Pt A): 204–213.
Rhee TG, Olfson M, Nierenberg AA, Wilkinson ST. 20-Year Trends in the Pharmacologic Treatment of Bipolar Disorder by Psychiatrists in Outpatient Care Settings. Am J Psychiatry. 2020 Aug 1;177(8):706-715. doi: 10.1176/appi.ajp.2020.19091000. Epub 2020 Apr 21. PMID: 32312111; PMCID: PMC7577523.