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Controversies Around Lithium

Guest Editors:
Michael J. Gitlin, MD, University of California, Los Angeles, USA  
Michael Bauer, MD, PhD, Technische Universität Dresden, Germany


The International Journal of Bipolar Disorders presents the Collection on Controversies around Lithium. Without a doubt, lithium is an essential medication for people with bipolar disorders and represents the most valuable treatment option in the prophylactic treatment for more than seven decades. From a historical perspective, since its establishment in the field of clinical psychopharmacology in the mid of the 20th century, several new aspects have been discovered in basic and clinical research, including anti-suicidal and antidepressant effects when used as an augmentation strategy. There is ample evidence that the capability of lithium long-term treatment to reduce the suicidal risk distinguishes it from the other mood stabilizers used in bipolar disorder. However, although studied for decades, there are still a lot of open questions around lithium. This thematic series is centred on unanswered concerns. The ultimate goal is to assist in unravelling the biological mechanisms behind lithium’s clinical effects in order to enhance diagnosis and therapy of bipolar disorders.

Image credit: Michael Bauer

  1. Lithium is effective in the long-term treatment of bipolar disorder. Concerns have been raised about non-responsiveness after discontinuation and resuming previously effective lithium prophylaxis. We reviewed ...

    Authors: Ralph Kupka, Eline Regeer, Annet van Bergen, Leonardo Tondo and Michael Bauer
    Citation: International Journal of Bipolar Disorders 2024 12:17
  2. Bipolar disorder is a broad diagnostic construct associated with significant phenotypic and genetic heterogeneity challenging progress in clinical practice and discovery research. Prospective studies of well-c...

    Authors: Anne Duffy and Paul Grof
    Citation: International Journal of Bipolar Disorders 2024 12:12
  3. Lithium (Li) remains one of the most valuable treatment options for mood disorders. However, current knowledge about prescription practices in Germany is limited. The objective of this study is to estimate the...

    Authors: Paul Kriner, Emanuel Severus, Julie Korbmacher, Lisa Mußmann and Florian Seemueller
    Citation: International Journal of Bipolar Disorders 2023 11:40
  4. Neonatal effects of late intrauterine and early postpartum exposure to lithium through mother’s own milk are scarcely studied. It is unclear whether described symptoms in breastfed neonates are caused by place...

    Authors: Essi Whaites Heinonen, Katarina Tötterman, Karin Bäck, Ihsan Sarman, Lisa Forsberg and Jenny Svedenkrans
    Citation: International Journal of Bipolar Disorders 2023 11:36
  5. The impact of long-term lithium treatment on weight gain has been a controversial topic with conflicting evidence. We aim to assess reporting of weight gain associated with lithium and other mood stabilizers c...

    Authors: Waldemar Greil, Mateo de Bardeci, Bruno Müller-Oerlinghausen, Nadja Nievergelt, Hans Stassen, Gregor Hasler, Andreas Erfurth, Katja Cattapan, Eckart Rüther, Johanna Seifert, Sermin Toto, Stefan Bleich and Georgios Schoretsanitis
    Citation: International Journal of Bipolar Disorders 2023 11:34
  6. For over half a century, it has been widely known that lithium is the most efficacious treatment for bipolar disorder. Yet, despite this, its prescription has consistently declined over this same period of tim...

    Authors: Gin S. Malhi, Erica Bell, Maedeh Jadidi, Michael Gitlin and Michael Bauer
    Citation: International Journal of Bipolar Disorders 2023 11:30
  7. Lithium is the preferred treatment for pregnant women with bipolar disorders (BD), as it is most effective in preventing postpartum relapse. Although it has been prescribed during pregnancy for decades, the sa...

    Authors: Noralie N. Schonewille, Pleun A. Terpstra, Maria E. N. van den Heuvel, Maria G. Van Pampus, Odile A. van den Heuvel and Birit F. P. Broekman
    Citation: International Journal of Bipolar Disorders 2023 11:24

Meet the Guest Editors

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Michael J. Gitlin: University of California at Los Angeles, USA

Michael J. Gitlin, MD, is Distinguished Professor of Clinical Psychiatry at the University of California at Los Angeles School of Medicine. He is currently Director of the Adult Division in the Department of Psychiatry, Medical Director of the Neuropsychiatric Behavioral Health Services, and Director of the Mood Disorders Clinic. He is the author of many scientific articles and book chapters as well as five books, including “The Essential Guide to Lithium Treatment” with Michael Bauer. Among his awards are: Distinguished Educator Award in Teaching from the UCLA Department of Psychiatry (1999) and the Leonard Tow Humanism in Medicine award from the Geffen School of Medicine at UCLA (2010).

Michael Bauer: Technische Universität Dresden, Germany

Michael Bauer, MD, PhD, is Professor of Psychiatry and Chair of the Department of Psychiatry and Psychotherapy at the Medical Faculty and Director of the Psychiatric Hospital of the Carl Gustav Carus University Hospital, Technische Universität Dresden. He is project coordinator of the National consortium for the German Treatment Guidelines for Bipolar Disorder, leads the National Research Network on Bipolar Disorder “BipoLife”, and is chair of the International Society for Bipolar Disorders (ISBD) Task Force “Role of Lithium in Bipolar Disorders”. From 2002-2022 he was President of the International Group for the Study of Lithium-Treated Patients (IGSLi). Together with Michael J. Gitlin he authored the textbook “The Essential Guide to Lithium Treatment” and is founder and editor-in-chief of the International Journal of Bipolar Disorders since 2013.

About the Collection

Without a doubt, lithium is an essential medication for people with bipolar disorders and represents the most valuable treatment option in the prophylactic treatment for more than seven decades. Amazingly, this ubiquitous occurring trace element can be considered the psychotropic medication with the longest clinical application in modern psychopharmacology. From a historical perspective, since its establishment in the field of clinical psychopharmacology in the mid of the 20th century, several new aspects have been discovered in basic and clinical research, including anti-suicidal and antidepressant effects when used as an augmentation strategy. There is ample evidence that the capability of lithium long-term treatment to reduce the suicidal risk distinguishes it from the other mood stabilizers used in bipolar disorder. Furthermore, basic research has solidly demonstrated in the previous decade that lithium possesses neuroprotective properties in animals and in vitro, and likely in humans as well when used prophylactically in people with bipolar disorder. 

However, although studied for decades, there are still a lot of open questions around lithium. Examples include: Does lithium have the potential to prevent dementia if used in very early stages of the disease or even prophylactically in people at high familiar risk? Does lithium have acute anti-suicidal effects? Why do the prescription rates decline in many countries given the extraordinary evidence of its effectiveness in the maintenance treatment of bipolar disorders and recommendations in international treatment guidelines? Does lithium long-term treatment reduce the risk of developing cancer? And being infected with the SarsCoV2 virus? Why does lithium in drinking water, where it appears as a trace element, reduce the suicide rate, although the concentrations are much higher when used as a medication to treat bipolar disorders? Are there ways to better predict the population among long-term lithium users who develop chronic renal disease? What are the biological mechanisms leading to the profound effectiveness to prevent episodes of mania and depression? 

This thematic series, which intends to approach some of these unanswered questions about lithium from a broad and multidisciplinary perspective, is centred on these and other unanswered concerns. The ultimate goal is to assist in unravelling the biological mechanisms behind lithium’s clinical effects in order to enhance diagnosis and therapy of bipolar disorders.