Lithium as the drug of choice for maintenance treatment in bipolar disorder

This is the authors' abstract. We don't add key points for this paper.

All international guidelines state lithium as a firstline maintenance treatment for bipolar disorder (1) but few give lithium primacy over other drugs (2). The paper by Hui (3) in the current issue of Acta Psychiatrica Scandinavica identified 6 predictors of good response to lithium in a meta-analysis of 71 studies including over 12,000 patients with bipolar disorder, while at the same time emphasizing that findings are heterogeneous and should be interpreted with cation due to potential biases and confounding. Until more strong and valid predictors emerge, this Editorial holds the position that lithium should be the drug of choice for maintenance treatment of bipolar disorder in general, that is, the single first-line treatment, as during the last decade the evidence for the maintenance effect and side-effects of lithium has increased substantially, as shortly summarized below.