Lithium was first used as a treatment for bipolar disorder in 1949. Yet despite decades of research and drug development, this simple medication remains the gold standard for treating one of the most complex psychiatric conditions. But why?
Clinically, bipolar disorder is defined as a mood disorder characterized by specific, lasting changes to a person's mood and energy levels. Depending on the type of bipolar disorder, individuals can experience manic, hypomanic and depressive episodes — either individually, or in sequence.
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A combination of antidepressants, antipsychotics, and mood-stabilizing anticonvulsants are often prescribed in combination to juggle these highly variable symptoms. "There are really very few medications that have an overall effect against both poles," Strawbridge said. Once stabilized, the challenge then becomes preventing relapse back into this destructive cycle.
"It's often considered the gold standard for bipolar disorder; it's helpful for the depression and for the mania, but its main benefit overall is in preventing relapse, so stopping either of those two types of episodes from coming back."
"Because lithium is quite a simple ion, it's able to disguise itself as sodium, and that means it can slip inside of brain cells, whereas most medications act on the surface of cells," she explained.
Simple lithium drugs are still the gold standard for treating bipolar disorder. (Image credit: Ray Geiger via Getty Images)"We know that the monoamine system and the neurotransmitters in the brain that are involved in reward emotions and cognition are disrupted," Victoria Wing, a clinical lecturer at the National Institute for Health and Care Research at Newcastle University and CNTW NHS Foundation Trust, told Live Science. Included in this disruption is the regulation of crucial mood molecules, such as dopamine and serotonin, which may be underactive or overactive depending on the nature of the bipolar episode.
"Lithium can also help with autophagy, which is the clearance of debris and toxins in cells, and it has antioxidant effects and boosts mitochondrial function, which are important for cell energy processes," Wing said.
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As with any medication, some side effects are unavoidable. The alternatives to lithium also carry their own risks. But if carefully and correctly managed, lithium medications can have a transformative impact for patients.
This article is for informational purposes only and is not meant to offer medical advice.
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