Recommendations in International Clinical Practice Guidelines for Lithium Therapy of Bipolar Disorder

Lithium is the gold-standard treatment for prophylaxis in bipolar disorder and has remained in pole position for the past 60 years in international guidelines. However, in practice, the perception that lithium is complicated to prescribe and associated with acute and long-term side effects constitutes a barrier to its effective prescription and management. In this chapter, we examine the positioning of lithium within current clinical practice guidelines for the treatment of bipolar disorder and describe how it is effective in quelling the acute symptoms of mania, as well as sustaining full and functional remission in prophylaxis, alongside conferring antisuicidal and neuroprotective benefits. We then discuss the specificity of lithium as a mood stabiliser and the recognition of an ideal lithium responder. The chapter also includes clinical advice regarding the prescription of lithium—emphasising the role of monitoring and measuring lithium plasma levels and using the ‘lithiumeter’ to optimise therapeutic levels and avoid toxicity.