Abstract
In the past twenty years, lithium was gradually less considered as a first choice option in the treatment of bipolar disorders, while clinicians tended to favor anticonvulsants or atypical antipsychotics. However, recent meta-analysis showed that lithium remains the “gold standard” in treating bipolar disorder. First of all, lithium has proven a superior efficacy as compared to other mood stabilizers, including a strong reduction of suicide conducts. Moreover, the benefit-risk ratio of lithium is higher than other mood stabilizers, especially in terms of overall reduction in all-cause of mortality in bipolar patients. Otherwise, the risk of ESRD was significantly overestimated in older studies; recent data have shown an extremely low prevalence over 20 to 30years of exposure to lithium, generally in patients overdosed, poorly monitored and often with other factors of renal vulnerability. Monitoring of treatment is easy: Renal function, plasmatic lithium, thyroid and para-thyroid monitoring. The serious iatrogenic risk of lithium is low; in light of current scientific data, the non-prescription of lithium in bipolar patients, especially those with a high suicide risk, may be considered as a medical malpractice. In conclusion, clinicians should favorise the choice of lithium as a first-line option in the treatment of bipolar patients, either as monotherapy or in combination with other mood stabilizers.
Published Version
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