GSM has served on a number of international and national pharmaceutical advisory boards, received funding for research, and has been in receipt of honoraria for talks at sponsored meetings worldwide involving AstraZeneca, Eli Lilly & Co., Jansen-Cilag, Organon, Pfizer, Sanofi-aventis, Servier, and Wyeth. SG and KNRC have no conflicts of interest to disclose in connection with this article. SG and KNRC as the co-editors of Bipolar Disorders, and GSM as the Guest Editor of this issue, did not participate in any editorial decisions to accept or reject this paper or in choosing any referees, which was overseen by the Managing Editor, who had no conflicts of interest in adjudicating this manuscript.
Lithium specificity in bipolar illness: a classic agent for the classic disorder
Version of Record online: 1 JUN 2009
© 2009 John Wiley & Sons A/S
Special Issue: Lithium and the Modern Management of Bipolar Disorder
Volume 11, Issue Supplement s2, pages 34–44, June 2009
How to Cite
Gershon, S., Chengappa, K. R. and Malhi, G. S. (2009), Lithium specificity in bipolar illness: a classic agent for the classic disorder. Bipolar Disorders, 11: 34–44. doi: 10.1111/j.1399-5618.2009.00709.x
- Issue online: 1 JUN 2009
- Version of Record online: 1 JUN 2009
- Received 8 March 2009, revised and accepted for publication 3 April 2009
- bipolar disorder;
- classic disorder;
- John Cade;
- major depression;
For over half a century, lithium has been the gold standard amongst the pharmacological armamentarium used to treat bipolar disorder. Its ascendancy in this regard has been attributed partly to its primacy of discovery and clinical implementation; however, it is important to consider how it has achieved success and retained its prominence and whether this is because of its unique profile and specificity of actions. In this paper, we briefly discuss the clinical evidence in support of lithium specificity and argue for its continuing use in those patients most likely to benefit, namely, patients with ‘classic’ bipolar disorder. Further, we suggest that accurate characterization of ‘lithium responders’ through focused research is likely to yield novel treatments and assist in better understanding of the pathophysiology of the illness. In addition, the unique antisuicidal actions of lithium warrant further examination, as do its impressive properties as a prophylactic agent. This is particularly so given the high morbidity associated with bipolar disorder and its potential for suicide. Hence, in this paper, after describing the changing diagnostic backdrop against which much of the research to date has been conducted, we discuss the clinical therapeutic profile of lithium in both the acute and long-term management of bipolar disorder and its phenotypic specificity of action. We demonstrate that lithium possesses significant clinical and therapeutic efficacy that is very individual and thus remains the treatment of choice for bipolar disorder when used specifically in select patients.