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Treatment of Bipolar Disorder in a Lifetime Perspective: Is Lithium Still the Best Choice?

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Abstract

Lithium preparations have been successfully used to treat bipolar disorder (BD), and remain the best established long-term treatment for the disorder. In fact, lithium is a cornerstone of treatment to minimize the risk of recurrences and improve inter-episodic symptomatology. We reviewed the available evidence for the use of lithium in the treatment of BD, including its efficacy, limitations, and potential benefits also in consideration of the different formulations available. We also overviewed salient comparative aspects regarding the long-term alternative use of anticonvulsants, antidepressants, and antipsychotics in BD patients. The available evidence indicates that BD patients should be treated primarily with lithium, combined in some cases with antipsychotics especially in acute treatments, and sometimes, because of intolerance or inefficacy of lithium, with anticonvulsants. The use of adjunctive antidepressants should be limited to episodes of breakthrough depression. Lithium should be offered to the majority of BD patients as initial treatment especially when suicide ideation or behavior is present with adequate information about its long-term benefits and its potential side effects. Many patients can tolerate lithium without concomitant use of antidepressants, which may worsen the course of the illness or antipsychotics, which may cause severe long-term side effects.

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Authors and Affiliations

  1. Neuroscience, Mental Health and Sensory Organ (NeSMOS) Department, Sapienza University, Rome, Italy

    Gabriele Sani

  2. Mood Disorder Lucio Bini Center, Cagliari, Rome, Italy

    Gabriele Sani & Leonardo Tondo

  3. School of Medicine, Tufts University, Boston, MA, USA

    Gabriele Sani

  4. Department of Experimental and Clinical Medicine, Section of Psychiatry, University of Pisa, Institute of Behavioral Sciences “G. De Lisio”, Pisa, Italy

    Giulio Perugi

  5. McLean Hospital-Harvard Medical School, Boston, USA

    Leonardo Tondo

  6. Sant’Andrea Hospital, Via di Grottarossa 1035, 00189, Rome, Italy

    Gabriele Sani

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Correspondence to Gabriele Sani.

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Prof. Gabriele Sani has acted as consultant of Lundbeck, Angelini and Janseen and is on the speaker/advisory board of Angelini and Lundbeck. Prof. Giulio Perugi has acted as consultant of Eli Lilly, Lundbeck, and Angelini; received grant/research support from Lundbeck; is on the speaker/advisory board of Sanofi Aventis, Angelini, Eli Lilly, Lundbeck, FB-Health. Prof. Leonardo Tondo has acted as a consultant for Angelini.

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Sani, G., Perugi, G. & Tondo, L. Treatment of Bipolar Disorder in a Lifetime Perspective: Is Lithium Still the Best Choice?. Clin Drug Investig 37, 713–727 (2017). https://doi.org/10.1007/s40261-017-0531-2

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