Efficacy of lithium in mania and maintenance therapy of bipolar disorder

Lithium was introduced in 1949 as a treatment for mania, for which there is still the strongest evidence of its efficacy. It has consistently yielded better results in the treatment of mania than neuroleptics and carbamazepine and equivalent results to divalproex. Its efficacy in bipolar depression remains inadequately studied. Lithium also provides benefit in prophylaxis. However, the percentage of patients persistently benefited is low, because it has both low efficacy in many symptomatic and illness course presentations of the disorder and low tolerability. Converging evidence from clinical and animal studies indicates that a principal behavioral effect of lithium is reduction of motor activity. Lithium is increasingly used in combined treatment regimens, often thereby allowing lower, better tolerated dosing and complementary benefits from drugs with different profiles of action.