Lithium: balancing risks and benefits

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Abstract
More than 20 years have passed since publication of the pivotal studies of efficacy upon which our use of lithium in acute mania and the prophylaxis of bipolar disorder are based. Since then, two of the most important discoveries about lithium have been the phenomenon of lithium withdrawal mania, and the recognition of permanent neurological sequelae after lithium toxicity. The use of lithium survived earlier criticism from the Institute of Psychiatry (Blackwell & Shepherd, 1968), but the new discoveries call for a reappraisal of the studies and reconsideration of whether lithium has a place in treatment, for which patients it should be recommended, what information and supervision should be given to patients on lithium, and what doctors should be expected to know of it.