Lithium was the, let me see. Yes, it was the third element to form in the universe,

right after hydrogen and helium. But we have some new evidence that places at first line

in bipolar disorder.

Welcome to the Carlet Psychiatry Podcast, keeping psychiatry honest since 2003. I'm Chris Agen, the editor-in-chief of the Carlyte Psychiatry podcast, keeping psychiatry honest since 2003.

I'm Chris Agen, the editor-in-chief of the Carlat Psychiatry Report.

And I'm Kelly Newsom, a psychiatric MP and a dedicated reader of every issue.

Last week, we talked about how to make a diagnosis of bipolar disorder using the rapid mood

screener.

Without it, only 30% of people with bipolar get an accurate diagnosis when they first come

to treatment, and this two-minute screener can increase those odds to 80%.

But even when the diagnosis is made in time, the right treatment doesn't always get followed.

Antidepressants are still the most common treatment, even in diagnosed bipolar, followed by antipsychotics.

Lithium, meanwhile, peaked in the 1980s in the early 90s, and since then, prescriptions for lithium have fallen by more than 50%.

But some see lithium as a disease-modifying agent in bipolar,

medication that not only treats the symptoms, but also reverses some of the pathophysiology behind the disorder. What that suggests is that

there's a window of opportunity where starting lithium early can change the course of the illness.

Today, we're going to look at the evidence for that, none of which is definitive, but all of which

is highly suggestive.

But before we get into the evidence, let's cut to the chase.

This isn't some left-field idea.

It's in the latest practice guidelines.

In 2023, the International Society for Bipolar Disorders published recommendations from the Task Force on early

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