title: The science and practice of lithium therapy.
abstract: BACKGROUND
  Despite more that 60 years of clinical experience, the effective use of lithium for the treatment of mood disorder, in particular bipolarity, is in danger of becoming obsolete. In part, this is because of exaggerated fears surrounding lithium toxicity, acute and long-term tolerability and the encumbrance of life-long plasma monitoring. Recent research has once again positioned lithium centre stage and amplified the importance of understanding its science and how this translates to clinical practice.
  
  
  OBJECTIVE
  The aim of this paper is to provide a sound knowledge base as regards the science and practice of lithium therapy.
  
  
  METHODS
  A comprehensive literature search using electronic databases was conducted along with a detailed review of articles known to the authors pertaining to the use of lithium. Studies were limited to English publications and those dealing with the management of psychiatric disorders in humans. The literature was synthesized and organized according to relevance to clinical practice and understanding.
  
  
  RESULTS
  Lithium has simple pharmacokinetics that require regular dosing and monitoring. Its mechanisms of action are complex and its effects are multi-faceted, extending beyond mood stability to neuroprotective and anti-suicidal properties. Its use in bipolar disorder is under-appreciated, particularly as it has the best evidence for prophylaxis, qualifying it perhaps as the only true mood stabilizer currently available. In practice, its risks and tolerability are exaggerated and can be readily minimized with knowledge of its clinical profile and judicious application.
  
  
  CONCLUSIONS
  Lithium is a safe and effective agent that should, whenever indicated, be used first-line for the treatment of bipolar disorder. A better understanding of its science alongside strategic management of its plasma levels will ensure both wider utility and improved outcomes.
authors.affiliation: CADE Clinic, Department of Psychiatry, Royal North Shore Hospital, Sydney, Australia. gin.malhi@sydney.edu.au
authors.forename: Gin S
authors.initials: GS
authors.lastname: Malhi
authors.forename: Michelle
authors.initials: M
authors.lastname: Tanious
authors.forename: Pritha
authors.initials: P
authors.lastname: Das
authors.forename: Michael
authors.initials: M
authors.lastname: Berk
mesh_terms: D018692:Antimanic Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000493:pharmacokinetics / Q000494:pharmacology / Q000627:therapeutic use*; D001714:Bipolar Disorder / Q000188:drug therapy* / Q000523:psychology; D004334:Drug Administration Schedule; D006801:Humans; D018020:Lithium Compounds / Q000008:administration & dosage / Q000009:adverse effects / Q000493:pharmacokinetics / Q000494:pharmacology / Q000627:therapeutic use*; D055118:Medication Adherence / Q000523:psychology; D008954:Models, Biological; D009435:Synaptic Transmission / Q000187:drug effects
chemical_list: D018692:Antimanic Agents; D018020:Lithium Compounds