Abstract
Malhi and coworker's editorial1 offers several reasons explaining the decline in the use of lithium to treat Bipolar Disorder (BD) against the recommendation of most international guidelines. Among the reasons, the authors state (1) the lack of "patent" on lithium, (2) its need for monitoring, and (3) concerns about its long-term adverse effects. Moreover, the authors refer to the displacement of lithium's prescription in favor of second-generation antipsychotics (SGA), highlighting that SGA may be useful for the management of BD, but do not confer the same prophylactic effectiveness for BD. While we could not agree more with the authors on this point, we believe that it is important also to remark the benefits of lithium in comparison to mood-stabilizing anticonvulsants (valproate, lamotrigine, and carbamazepine). We think that these compounds, along with SGA, are the ones that have relegated lithium to a second- or even third-line option for many clinicians treating patients with BD.
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