Evidence suggests that lithium should still be first choice for prophylactic treatment

Bipolar affective disorder, also called manic depression, is a common condition associated with multiple relapses often leading to unemployment, marital problems, alcohol abuse, and suicide. The lifetime prevalence is more than 1%, and 10-20% of patients commit suicide. Cade was the first to report the anti-manic effect of lithium, and by the late 1960s its role in the prophylaxis of bipolar disorder was established.1 In the next decade it became widely used on both sides of the Atlantic as the first line of treatment for the condition. Recent prescribing patterns indicate that the use of lithium in the United States is declining relative to its use in European and other countries such as Australia. The evidence, however, suggests that lithium should be the first choice in the prophylactic treatment of most patients with bipolar disorder.

Some American clinicians no longer prescribe lithium because it is too toxic and alternatives are available. Marketing strategies for mood stabilisers such as valproate and …