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Lithium Renaissance2025-08-11

Lithium is enjoying a well-deserved second act.

It has been one of the first medications used in psychiatry. Over the years, it had been used primarily at high doses, for full-blown bipolar disorder (manic- depressive illness). Lithium blood levels and ranges were developed based on acute treatments in those very ill patients. That “therapeutic range” became the guideline and dogma, and medium to high lithium dosage the norm. At those levels however, most people get side-effects sooner or later, and have to abandon the medication. Thus, lithium acquired a bad reputation, and started to be used less and less, displaced by newer and more heavily advertised drugs, such as antipsychotics promoted as “mood stabilizers”.

Experienced and sophisticated psychiatrists have continued to use lithium. It is the best single medication we have in psychiatry, followed closely by clozapine. Both of them, not coincidentally, are the only two medications FDA approved for suicidality prevention.

Over the last two decades, in my own clinical practice, academic research work, and biomarker studies, it has become clear to me that low dose lithium (emphasis on low) works very well long-term for treatment and for prevention, usually as an add-on therapy, and can be used broadly as a neuronal function optimizer across disorders (mood disorders, stress, suicidality, and others- we have upcoming papers indicating usefulness in additional disorders). It also promotes neuronal survival, relevant to neurodegenerative disorders like Alzheimer.

The MindX One comprehensive liquid biopsy offered by MindX Sciences helps with differential diagnosis and matches people to existing medications based on their biology. Surprisingly often (or we should not be surprised anymore at this point), the top match is lithium. In case after case, complex “treatment-refractory” patients have done very well after low dose lithium was added and their medication regimen simplified, moving on with their lives.