Lithium revisited.
OBJECTIVE
To review lithium's utility in the treatment of mood disorders.


METHODS
We reviewed the safety, tolerability, teratogenicity, optimal dosing regimens, and mortality-lowering effects of lithium. Clinical relevance and scientific rigour determined which articles we selected for review.


RESULTS
Lithium is the paradigmatic treatment for bipolar disorder (BD). In treating BD, optimal maintenance plasma levels may be approximately 0.75 to 0.85 mEq/L. Although nephrogenic diabetes insipidus is not uncommon, irreversible renal failure due to lithium appears to be a rare, idiosyncratic event. Lithium-induced cardiovascular teratology appears to be less common than previously thought. Optimal lithium dosing may be once daily, this agent appears to bestow a robust suicide-lowering effect, and emerging data hint at neurotrophic and neuroprotective effects.


CONCLUSIONS
Lithium remains an effective and integral agent in the treatment of BD. Its ability to lower suicide rates in persons with BD warrants clinical attention.
McIntyre
R S
RS
Bipolar Clinic, Centre for Addiction and Mental Health, 250 College Street, Toronto, ON M5T 1R8. Roger_McIntyre@camh.net
Mancini
D A
DA
Parikh
S
S
Kennedy
S H
SH
D016907:Adverse Drug Reaction Reporting Systems; D001714:Bipolar Disorder / Q000188:drug therapy* / Q000401:mortality / Q000523:psychology; D002423:Cause of Death; D006801:Humans; D018020:Lithium Compounds / Q000009:adverse effects / Q000627:therapeutic use*; D013405:Suicide / Q000706:statistics & numerical data; D016896:Treatment Outcome; D000092864:Suicide Prevention
D018020:Lithium Compounds