The science and practice of lithium therapy

Malhi, Gin S., Tanious, Michelle, Das, Pritha and Berk, Michael 2012, The science and practice of lithium therapy, Australian and New Zealand journal of psychiatry, vol. 46, no. 3, pp. 192-211, doi: 10.1177/0004867412437346.

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Title The science and practice of lithium therapy
Author(s) Malhi, Gin S.
Tanious, Michelle
Das, Pritha
Berk, MichaelORCID iD for Berk, Michael
Journal name Australian and New Zealand journal of psychiatry
Volume number 46
Issue number 3
Start page 192
End page 211
Total pages 20
Publisher Sage Publications
Place of publication London, England
Publication date 2012-03
ISSN 0004-8674
Keyword(s) bipolar disorder
mood stabilizer
Summary Introduction: Despite more that 60 years of clinical experience, the effective use of lithium for the treatment of mood disorder, in particular bipolarity, is in danger of becoming obsolete. In part, this is because of exaggerated fears surrounding lithium toxicity, acute and long-term tolerability and the encumbrance of life-long plasma monitoring. Recent research has once again positioned lithium centre stage and amplified the importance of understanding its science and how this translates to clinical practice.

Objective: The aim of this paper is to provide a sound knowledge base as regards the science and practice of lithium therapy.

Method: A comprehensive literature search using electronic databases was conducted along with a detailed review of articles known to the authors pertaining to the use of lithium. Studies were limited to English publications and those dealing with the management of psychiatric disorders in humans. The literature was synthesized and organized according to relevance to clinical practice and understanding.

Results: Lithium has simple pharmacokinetics that require regular dosing and monitoring. Its mechanisms of action are complex and its effects are multi-faceted, extending beyond mood stability to neuroprotective and anti-suicidal properties. Its use in bipolar disorder is under-appreciated, particularly as it has the best evidence for prophylaxis, qualifying it perhaps as the only true mood stabilizer currently available. In practice, its risks and tolerability are exaggerated and can be readily minimized with knowledge of its clinical profile and judicious application.

Conclusion: Lithium is a safe and effective agent that should, whenever indicated, be used first-line for the treatment of bipolar disorder. A better understanding of its science alongside strategic management of its plasma levels will ensure both wider utility and improved outcomes.
Language eng
DOI 10.1177/0004867412437346
Field of Research 110399 Clinical Sciences not elsewhere classified
Socio Economic Objective 970111 Expanding Knowledge in the Medical and Health Sciences
HERDC Research category C1 Refereed article in a scholarly journal
Copyright notice ©2012, Sage publishers
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Document type: Journal Article
Collections: Faculty of Health
School of Medicine
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