• bipolar disorder;
  • dosing schedule;
  • lithium;
  • maintenance;
  • side effects;
  • toxicity;
  • treatment regimen

Malhi GS, Tanious M, Gershon S. The lithiumeter: a measured approach. Bipolar Disord 2011: 13: 219–226. © 2011 The Authors. Journal compilation © 2011 John Wiley & Sons A/S.

Background:  Lithium has long been recognised for its mood-stabilizing effects in the management of bipolar disorder (BD) but in practice its use has been limited because of real and ‘imagined’ concerns. This article addresses the need for lithium to be measured with respect to its clinical and functional effects. It introduces a visual scale, termed lithiumeter, which captures the optimal lithium plasma levels for the treatment of BD.

Methods:  Key words pertaining to lithium’s administration, dosing, and side effects as well as its efficacy in acute and long-term treatment of BD were used to conduct an electronic search of the literature. Relevant articles were identified by the authors and reviewed.

Results:  This paper outlines the considerations necessary prior to initiating lithium therapy and provides a guide to monitoring lithium plasma levels. Current recommendations for optimal plasma lithium levels in the management of BD are then discussed with respect to indications for use in the acute phases of the illness and maintenance therapy. The risks associated with lithium treatment are also discussed.

Conclusions:  The lithiumeter provides a practical guide of optimal lithium levels for the clinical management of BD.