ABSTRACT
Lithium can produce dramatic benefits for patients with bipolar disorders. It is the treatment of choice for individuals suffering from the classical, episodically recurring type of bipolar disorder, particularly for their long-term stabilization. Lithium is also suitable for a therapeutic trial in some other types of bipolar illnesses. Presenting a balanced, evidence-based perspective on this fascinating salt, however, poses a challenge, given the major controversies that have been raging about the use of lithium in the literature. Over the past four decades, investigators and clinicians have made a variety of observations under different experimental designs, and their interpretations and conclusions reflect their varied experience. In the late 1960s and 1970s, lithium was used in patients with bipolar disorders diagnosed primarily according to the Kraepelinian tradition, after a careful exclusion of all other psychiatric diagnoses, comorbidities, and the pre-emption of those with mood-incongruent psychotic symptoms. The outcome of lithium clinical trials from that time period was very satisfactory and the findings replicable. Bipolar illness suddenly became treatable with medication, lithium being the first effective agent; the management of bipolar disorder changed from episodic to long term; and biological concepts in psychiatry received a major boost of confidence, reflected in a huge expansion of research activities.
