Efficacy of Lithium in Mania and Maintenance Therapy of Bipolar Disorder

Lithium was introduced in 1949 as a treatment for mania, for which there is still the strongest evidenceof its efficacy. It has consistently yielded better results in the treatment of mania than neurolepticsand carbamazepine and equivalent results to divalproex. Its efficacy in bipolar depression remainsinadequately studied. Lithium also provides benefit in prophylaxis. However, the percentage of patientspersistently benefited is low, because it has both low efficacy in many symptomatic and illnesscourse presentations of the disorder and low tolerability. Converging evidence from clinical and animalstudies indicates that a principal behavioral effect of lithium is reduction of motor activity. Lithiumis increasingly used in combined treatment regimens, often thereby allowing lower, better tolerateddosing and complementary benefits from drugs with different profiles of action.