The role of lithium in the treatment of bipolar disorder

When compared to other mood stabilizers and atypical antipsychotics, lithium has been shown to have a similar treatment efficacy to valproate, olanzapine, risperidone and haloperidol in the management of acute manic and mixed episodes. Lithium was also suggested to be more effective in patients with mania, compared to valproate and olanzapine. However, lithium has a reported slower onset of action compared to antipsychotics, i.e., 6-10 days for lithium, compared to 2-6 days for antipsychotics. Previous work suggests that lithium has less efficacy in the treatment of bipolar depression compared to quetiapine, and antidepressants such as venlafaxine. However, the antidepressant effect of lithium has been reported to have a delayed onset of 6-8 weeks. In clinical practice, a combination of lithium with other agents is considered to be effective in the treatment of bipolar depression, is more likely to be administered, and despite limited evidence, lithium remains important in the treatment of bipolar depression.