Examining Lithium as the Benchmark Mood Stabilizer for Bipolar Disorder Treatment

Join us for an insightful Q&A with Jonathan Meyer, MD, voluntary clinical professor of psychiatry at the University of California, San Diego, while he delves into why lithium is heralded as the gold standard mood stabilizer for patients with bipolar disorder with a history of mania. Dr Meyer discusses the limited evidence-based options available, the unique benefits of lithium, and how it stands out despite the adverse effects associated with its use. Gain valuable knowledge on optimizing lithium treatment, managing its side effects, and understanding its critical role in both acute mania and long-term maintenance. 

Answers have been lightly edited for clarity. 

Psych Congress Network: Why do you describe lithium as the gold standard mood stabilizer for bipolar disorder patients with a history of mania?

Dr Jonathan Meyer: Patients with a history of mania really have limited evidence-based options for mood stabilizers. There's an older anti-convulsant, carbamazepine, which works, but also causes a lot of drug-drug interactions. Valproate had been very popular for years, but increasingly we're realizing it cannot be used in women of reproductive potential. Those issues aside, lithium has been the gold standard, partly because it could be used in acute mania, but also offers the optimum maintenance combination of both mania prophylaxis as well as some reduction in depression along with its anti-suicide properties.

PCN: What other adverse effects should clinicians be on the lookout for when treating patients with lithium? How can these be minimized?

Dr Meyer: Lithium, of course, does have an array of adverse effects. The one thing that mostly concerns clinicians are its long-term renal adverse effects. One thing we've learned over the years is that giving lithium once a day helps reduce this risk as well as keeping your maintenance levels between the sweet spot of 0.6 to 0.8, but never higher than 1.0. There are some other common adverse effects which are worth monitoring for and are generally easily managed, such as its impact on the risk for hypothyroidism and tremor, as well as some GI side effects.

PCN: How should clinicians use lithium in clinical practice?

Dr Meyer: As we've learned about the reproductive harms of valproate, we now recognize that for people with a history of mania, which means bipolar I disorder and schizoaffective disorder, bipolar type, they need to be on a mood stabilizer. And we're now left with two evidence-based options: lithium and carbamazepine.

Lithium has a number of advantages, as we've discussed before. It's not that difficult to use. By attending some classes, doing a little bit of reading, you can become adept at using lithium and really offer your patients what we still think is the gold standard mood stabilizer for those who have a history of mania.

Jonathan Meyer, MD, is a voluntary clinical professor of psychiatry at University of California, San Diego, and a distinguished life fellow of the American Psychiatric Association. Dr Meyer is a graduate of Stanford University and Harvard Medical School, finished his adult psychiatry residency at LA County-USC Medical Center and completed fellowships there in Consultation/Liaison Psychiatry and Psychopharmacology Research. Dr Meyer has teaching duties at UC San Diego and the Balboa Naval Medical Center in San Diego, and is a consultant to the first episode psychosis program at Balboa NMC.