Lithium revisited

Objective: To review lithium's utility in the treatment of mood disorders. Method: We reviewed the safety, tolerability, teratogenicity, optimal dosin g regimens, and mortality-lowering effects of lithium Clinical relevance an d scientific rigour determined which articles we selected for review. Results: Lithium is the paradigmatic treatment for bipolar disorder (BD). I n treating BD, optimal maintenance plasma levels may be approximately 0.75 to 0.85 mEq/L. Although nephrogenic diabetes insipidus is not uncommon, irr eversible renal failure due to lithium appears to he a rare, idiosyncratic event. Lithium-induced cardiovascular teratology appears to be less common than previously, thought. Optimal lithium dosing may be once daily, this ag ent appears to bestow a robust suicide-lowering effect, and emerging data h int at neurotrophic and neuroprotective effects. Conclusion: Lithium remains an effective and integral agent in the treatmen t of BD. Its ability to lower suicide rates in persons with BD warrants cli nical attention.