SUMMARY
Still after more than 50 years, lithium is a major treatment of bipolar disorder, even though
it has not been promoted by the pharmaceutical industry over the last decades. In recent
years the evidence base on lithium for bipolar disorder has substantially increased due to
results from a number of trials. Therefore, a review of this evidence is timely. The efficacy
of lithium as an acute treatment and as a maintenance treatment of bipolar disorder was
evaluated through a review of the evidence, focusing on modern, randomized, parallel group
designed trials. Additionally, the evidence was sought translated into the proper use
of lithium in clinical practice. Lithium’s anti manic 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 mono therapy 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.