Could Lithium Be Preserved for the Stabilization of Bipolar Patients?

Lithium remains endorsed as first-line treatment for bipolar disorders across major clinical guidelines, yet robust evidence demonstrates its progressive decline in use in psychiatric practice across numerous countries. To justify this decline, concerns regarding lithium's efficacy, safety profile, and monitoring requirements are frequently cited. Yet, these apprehensions largely stem from misunderstanding of lithium's clinical uses. In fact, when patients are selected for lithium stabilization according to a characteristic clinical profile and not just a bipolar verdict, lithium continues demonstrating excellent efficacy compared to all other psychiatric medications currently available. Moreover, after sufficient clinician and patient education regarding lithium stabilization principles, monitoring requirements stop being burdensome. Furthermore, among lithium-responsive patients, adverse effects are typically mild and clinically manageable, except for glomerular filtration rate decline, which tends to develop after decades of continuous administration. Thus, it may be possible to reverse this unfortunate decline in lithium's use by teaching clinicians to identify the patient profile responsive to lithium stabilization, by investigating intermittent lithium administration to mitigate renal complications, and by implementing educational programs regarding optimal lithium utilization for psychiatrists, patients, and their families.