More confirmation that family history guides response
STUDY: Alda M et al, European Neuropsychopharmacology 2026;110:112831
STUDY TYPE: Multicenter observational family study
FUNDING: ERA PerMed program, Dalhousie Medical Research Foundation, Canadian Institutes of Health Research
Background
Around 1 in 3 patients with bipolar are excellent lithium responders, and signs of that include:
- Pure, euphoric manias or hypomanias followed by depressions
- Good functioning between episodes
- Onset age 15-20
- Lack of comorbidities (except panic disorder may predict response)
Earlier work hinted that lithium response runs in families, and this international study put that hypothesis to a more rigorous test.
The Study
- 92 biological relatives of 78 patients rated as lithium responders or non-responders
- Comparison group: 78 unrelated patients with bipolar disorder
Among relatives of lithium responders, 69% were also good responders.
Among relatives of non-responders, only 22% had a good lithium response, a rate nearly identical to the unselected comparison group (31%).
Odds of responding = 7.8 times higher in families of responders than non-responders.
The association held for first-degree relatives and was not explained by comorbid anxiety or substance use.
Limitations: The sample was modest in size and drawn from specialty lithium clinics, so these patients were well-monitored and largely adherent.
Practice Implications
- Before starting a new bipolar patient on lithium, ask about family members with bipolar disorder or recurrent depression: did lithium work for them?
- Learn how lithium went from a wellness fad to a therapy for bipolar in our two-part Carlat Podcast.
— Chris Aiken, MD
Director, Psych Partners
Editor in Chief, Carlat Psychiatry Report
