What is the role of Lithium in the treatment of bipolar disorder?
Lithium has long been considered the mainstay of pharmacologic therapy for bipolar disorder. In the United States, it was approved in 1970 for the management of acute mania and in 1974 for maintenance therapy. Lithium continues to be used globally for the treatment of bipolar disorder, for both acute and maintenance therapy. Its mechanism of action is unknown, but is believed to involve the modification of second-messenger systems.
However, lithium has numerous disadvantages. When used as monotherapy, lithium is associated with a poor response rate. Lithium appears to be most effective for individuals with “euphoric” or “pure” mania, mild mania, and people with a family history of response. However, people with more severe mania, psychotic mania, mixed mania, rapid cycling, or comorbid substance abuse tend to respond poorly. In addition, many people undergoing long-term treatment develop a resistance to lithium. Furthermore, lithium has a very narrow therapeutic window; patients who exceed the recommended blood concentration of lithium may experience lithium toxicity. Moreover, lithium has an unfavorable side-effect profile.
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