Lithium: The Forgotten Wonderdrug

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Acute Manic or Mixed Episodes • Mild/Moderate – First line, lithium monotherapy or valproate or antipsychotic like olanzapine • Severe – First line is initiation of lithium plus an antipsychotic or valproate and an antipsychotic • If the episode is breakthrough while patient is already on lithium maintenance – Optimize dose – Add valproate to the lithium
Bipolar Depression • First line therapy is initiation of lithium or lamotrigine – Antidepressant monotherapy is not recommended – Can initiate lithium with antidepressant together • If the episode is breakthrough while patient is already on lithium maintenance – Optimize dose – Add lamotrigine and/or bupropion to the lithium
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Lithium: The Forgotten Wonderdrug W
Page 3:
What Is Lithium
Page 7 and 8:
History • 1880s to early 1900s li
Page 9 and 10:
Psychiatric Uses For Lithium • An
Page 11 and 12: Advantages of Lithium • Well esta
Page 13 and 14: Decline In Lithium Use
Page 15 and 16: Trend in Veterans Affairs Medical C
Page 17 and 18: Lithium Therapy And Suicide Risk In
Page 19 and 20: Suicide Risk in Mood Disorders •
Page 21 and 22: Overall Rates • Suicides and atte
Page 23 and 24: Rates of Suicide Attempts • Suici
Page 25 and 26: Risk Reduction in Diagnostic Subtyp
Page 27 and 28: Other Important Risk Factors in Sui
Page 29 and 30: Limitations of Evidence • Lack of
Page 31 and 32: Rationale For Long Term Treatment W
Page 33 and 34: Relapse in Bipolar Disorder • Des
Page 35 and 36: Episode Recurrence in Bipolar I Dis
Page 37 and 38: Episode Recurrence in Bipolar I Dis
Page 39 and 40: Reduction of Episode Recurrence •
Page 41 and 42: Risk vs Benefit Of Lithium Maintena
Page 43 and 44: Potential Toxicity of Long Term Lit
Page 45 and 46: Reducing Risk, Increasing Benefit:
Page 47 and 48: Initiating and Monitoring Lithium T
Page 49 and 50: Initiating Lithium • Prior to ini
Page 51 and 52: Blood Monitoring • Lithium can be
Page 53 and 54: Therapeutic Levels • Upper end: 1
Page 55 and 56: Lithium Discontinuation
Page 57 and 58: Reduced Morbidity After Gradual Dis
Page 59 and 60: Lithium Discontinuation and Subsequ
Page 61: APA Treatment Guidelines For Bipola
Page 65 and 66: Maintenance “The medications with
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Lithium: The Forgotten Wonderdrug

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