Lithium was used for general health long before it became a psych med, marketed in spring water and 7-UP with advertisements that probably wouldn’t pass today
Response fades with every year of delay
STUDY: Nylander P-O et al, Biol Psychiatry Glob Open Sci 2026
STUDY TYPE: Retrospective, naturalistic follow-up study
FUNDING: Swedish government and academic foundations
Background
Practice guidelines recommend lithium first-line for bipolar disorder, and some studies suggest benefits when started early. This one adds long-term follow up to the dataset.
The Study
- 192 patients with bipolar disorder type I or II, followed up to 25 years before and during lithium.
- Response was episodes per year before lithium versus on lithium, split at the median improvement of 68%.
- Patients were grouped by years of illness before starting lithium, and logistic regression tested the trend.
Results
Starting lithium within 3 years of the first episode gave the best odds of response. That fell as it was started later, with responses of
- 69% within first 3 years
- 50% 3-8 year delay
- 44% 8-17 year delay
- 40% beyond 17 years
Adjusted for sex, age, and follow-up time, each added quartile of delay lowered the odds further. The decline was continuous. Bipolar-II patients waited longer than type I (15.4 years versus 10.6), but delay, not diagnosis, was what influenced the difference.
Limitations
This retrospective design shows an association, not proof that delay causes the decline. It’s unclear if this is unique to lithium, but other studies show better long-term and functional outcomes with lithium vs other mood stabilizers, particularly compared to antipsychotics.
Practice Implications
- Learn more on how to diagnose bipolar early, and timing and lithium in our Carlat Podcast.
—Chris Aiken, MD
Director, Psych Partners
Editor in Chief, Carlat Psychiatry Report
