Lithium therapy in bipolar disorder: a balancing act?

摘要

Commentwww.thelancet.comVol 386 August 1, 2015 415Quite reasonably, patients with bipolar disorder want treatment that provides sustained relief from their illness without incurring serious side-eff ects. Functionally, this translates to the resumption of purpose and enjoyment. But of the numerous drugs available for the management of bipolar disorder, only lithium seems to truly stabilise mood.1 Its status as an eff ective prophylactic agent was convincingly reinstated by the fi ndings of the randomised, open-label BALANCE trial,2 which corroborated empirical knowledge. The BALANCE investigators showed that lithium alone, or lithium plus valproate, are more likely to prevent relapse than valproate monotherapy, and prophylaxis with lithium monotherapy might be on a par with lithium plus valproate. Hence, despite fl uctuating popularity, lithium remains a fi rst-line option for the treatment and prophylaxis of bipolar disorder in therapeutic guidelines.3 However, use of lithium in practice is limited by concerns about safety and adverse eff ects with long-term use.