title: Lithiumeter: Version 2.0.
abstract: The Lithiumeter was developed as a visual and practical guide for determining lithium levels in the management of bipolar disorder (BD). It appears to have been well received, as evidenced by its increasing popularity amongst doctors as a deskside clinical aide, and adoption and reproduction of the schematic in clinical guidelines and texts. However, since its publication 5 years ago, key basic neuroscience and clinical research developments pertaining to lithium have significantly advanced our understanding, necessitating further refinement of guidance concerning the practicalities of lithium therapy.
  
  
  
  Literature concerning the indications for, and therapeutic levels of, lithium and the associated acute and chronic risks of therapy was scrutinized as part of updating clinical practice guidelines. We have reviewed these updates and identified significant areas of change with respect to the previous Lithiumeter (version 1.0).
  
  
  
  Since 2011, updated clinical practice guidelines have narrowed the indicated plasma lithium concentration for maintenance therapy, suggesting that additional guidance is necessary for optimizing treatment. Relevant updated clinical guidance was integrated to constitute the Lithiumeter 2.0, which provides a more comprehensive overview of the practical aspects of lithium therapy while maintaining a focus on optimization of lithium levels, such as differential titration of lithium depending on the current mood state.
  
  
  
  The Lithiumeter 2.0 is an update that clinicians will find useful for their practice. By addressing some of the issues faced in clinical practice, translational clinical research will continue to inform the Lithiumeter in future updates.
authors.affiliation: Academic Department of Psychiatry, Northern Sydney Local Health District, St Leonards, NSW, Australia.|Sydney Medical School Northern, The University of Sydney, Sydney, NSW, Australia.|CADE Clinic, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW, Australia.
authors.forename: Gin S
authors.initials: GS
authors.lastname: Malhi
authors.affiliation: Emeritus Professor of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA.|Mind and Brain Theme, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, SA, Australia.
authors.forename: Samuel
authors.initials: S
authors.lastname: Gershon
authors.affiliation: Academic Department of Psychiatry, Northern Sydney Local Health District, St Leonards, NSW, Australia.|Sydney Medical School Northern, The University of Sydney, Sydney, NSW, Australia.|CADE Clinic, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW, Australia.
authors.forename: Tim
authors.identifier: 0000-0003-2534-3635
authors.initials: T
authors.lastname: Outhred
mesh_terms: D018692:Antimanic Agents / Q000627:therapeutic use; D001714:Bipolar Disorder / Q000188:drug therapy; D019719:Diagnostic Equipment; D064420:Drug-Related Side Effects and Adverse Reactions / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control; D006801:Humans; D008094:Lithium / Q000032:analysis / Q000627:therapeutic use
chemical_list: D018692:Antimanic Agents; D008094:Lithium
keywords: bipolar depression; bipolar disorder; clinical practice; lithium; mania