When do you consider lithium for early intervention in those identified to be at risk for bipolar disorder?  

Lithium is the preferred first-line agent for bipolar disorder. It offers patients the potential for as close to a cure (restituo ad integrum) as you can get in psychiatry. For this case, I would initiate a 150 mg dose, and potentially build to a low-moderate dose (300-450 qhs) and watch and wait ov...

You have to take into account the patient population that you’re going to use lithium with. Are they going to be responsible with their food and liquid intake, as well as be aware of what their medications are? No, you can’t take certain antihypertensives. You also have to make sure that...

I am aware that many consider lithium the holy grail. However, given the numerous options in the treatment of bipolar disorder, I do not use lithium as a first-line agent. I say this because of adverse event considerations such as tremor, thyroid, and renal considerations. Most of my patients have...

I use a lot of lithium 150-450 HS, and it has been an amazingly positive experience for my patients with mood disorders. I have often gotten "Why hasn't this been tried earlier?" I do not feel the need for a higher level of 0.8 even for BAD1 with mania. We may go to 1.1 while manic and then decrease...

I'm not sure what is meant by the question "at risk for bipolar disorder". I am going to assume it means someone with a very strong family history of bipolar disorder but who has never experienced symptoms of bipolar disorder, with no history of mania or hypomania. If this patient has also experienc...

Personally, I do not use lithium as a first-line agent, especially since much of my clientele has significant medical comorbidity. I would use lithium if other classes of agents are ineffective or insufficient, however.

Lithium shines as an agent in the treatment of bipolar mania and decent agent for maintenance. It would NOT be my first line for bipolar depression. Typically, I think of it as treating from "above". That being said, when we get to desperate situations, where all is failing, we sometimes layer on si...

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