The Lancet published an opinion paper by a group of scientists from the USA and Canada arguing that lithium should be recognized as a disease-modifying drug for bipolar disorder.

Bipolar disorder, characterized by extreme mood swings, tends to worsen over time with each additional mood episode, especially in the absence of effective treatment. It is also associated with an increased risk of cardiovascular disease and dementia.

The authors cite a meta-analysis of observational studies that included 14,000 patients. This analysis showed that lithium was superior to several antipsychotics and anticonvulsants, including quetiapine and valproate, in preventing rehospitalization and relapse. Other studies indicate that lithium also works well in combination therapy, improving outcomes in both acute and long-term treatment.

Although the precise biological mechanisms of bipolar disorder remain unclear, lithium has effects at the genetic, cellular and brain levels. 

Research shows that for people with bipolar disorder, “lithium reduces the risk of cardiovascular disorders, dementia, osteoporosis, and all-cause mortality.”

Bipolar disorder is harder to treat in the later stages of illness.

The paper emphasizes the importance of early intervention with lithium, particularly for a first manic episode. 

Lithium appears to protect better than other drugs against mortality, suicide, cognitive decline, and reduces the duration and severity of both manic and depressive episodes. It also demonstrated efficacy in treating acute manic episodes as well as in preventing relapses of mood episodes.

Read more in the original article.