Lithium Prescribing and Monitoring in Clinical Practice – A Practical Guide
In 2016, Kessing and colleagues published data on the prescription patterns of patient’s who were first diagnosed with bipolar disorder. 
Major changes were reported with drug prescription choices over the period from 2000 to 2011 with antiepileptic and atypical antipsychotics were prescribed substantially more than lithium, despite lithium having a substantial evidence base as a mood stabiliser with proven efficacy in acute mania, long-term prophylaxis of bipolar disorder and to a lesser extent in depressive disorders.
A recent Nature article quoted:
New data indicate the importance of long-term prophylaxis after a first manic episode to lessen episode recurrence, allow cognition to recover to normal, and prevent various aspects of illness progression. Given the highly recurrent and progressive course of bipolar disorder sometimes even in the face of conventional treatment, the role and enhanced use of lithium deserves reconsideration.
We covered the neuroprotective effect of lithium and a summary of its mechanism of action in a previous article.
Another article provides a more comprehensive synopsis of Lithium’s mechanism of action along with a visual guide.
In this article, we focus on the practical aspects of prescribing lithium in clinical practice.
Ratheesh A, Hett D, Ramain J, Wong E, Berk L, Conus P, Fristad MA, Goldstein T, Hillegers M, Jauhar S, Kessing LV, Miklowitz DJ, Murray G, Scott J, Tohen M, Yatham LN, Young AH, Berk M, Marwaha S. A systematic review of interventions in the early course of bipolar disorder I or II: a report of the International Society for Bipolar Disorders Taskforce on early intervention. Int J Bipolar Disord. 2023 Jan 3;11(1):1.
Nolen, W. A., Licht, R. W., Young, A. H., Malhi, G. S., Tohen, M., Vieta, E., … & Severus, E. (2019). What is the optimal serum level for lithium in the maintenance treatment of bipolar disorder? A systematic review and recommendations from the ISBD/IGSLI Task Force on treatment with lithium. Bipolar disorders, 21(5), 394-409.