Lithium comeback: The use of the ‘penicillin of psychiatry’ to treat bipolar disorder is resurging

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A quick literature search for lithium therapy reveals a multitude of recent articles on its superior efficacy in the treatment of mood disorder—and its underutilization in favor of other, newer agents ….

Now, a new paper published in the Australian and New Zealand Journal of Psychiatry concludes that “in practice, lithium should be prescribed to all [emphasis added] patients with bipolar disorder, unless there is a specific reason why an alternative is preferable or is better suited” (Malhi et al., 2020).

A frequent concern raised about lithium therapy is the risk of side effects, including lithium toxicity, which occurs when lithium is dosed too high or is taken in overdose. However, … lithium’s side effects are often overestimated by prescribers, and the drug’s long-term safety at appropriate doses has been well-established. Years of anti-lithium advertising by the pharmaceutical companies has contributed to these negative perceptions surrounding lithium treatment.

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Fortunately, there now appears to be broad consensus in academic psychiatry that lithium, long-recognized as the single most effective mood-stabilizing agent, is underused—and that this represents a major problem in bipolar disorder treatment. Psychiatry’s “orphan drug,” long unsupported by any major pharmaceutical company, may be making a comeback.

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