Additionally, the evidence was sought translated into the proper use
of lithium in clinical practice. Lithium’s antimanic efficacy has been convincingly demonstrated.
However, as blood monitoring due to the risk of toxicity is required and due to an
insufficient response in highly agitated patients, lithium monotherapy has a limited place in
the acute treatment of severe manic states. For acute bipolar depression, results are conflicting.
Recent maintenance trials have added substantially to the documentation of lithium’s
long-term stabilizing properties in bipolar disorder, and these properties have been demonstrated
independently of any acute response to lithium. Finally, it is now beyond doubt that
not only does lithium prevent mania, but also depression in bipolar disorder. Lithium is still
to be considered a major if not the most important mood- stabilizer, at least for maintaining
long-term stability in patients with bipolar disorder. The potential risks of lithium should be
weighed up against its benefits and the fact that serious adverse effects are usually avoidable