Lithium Performance in Bipolar Affective Disorder: Moving Towards Personalized Therapeutics
DOI:
https://doi.org/10.5281/zenodo.21809844Keywords:
Combination Pharmacotherapy, Lithium Monitoring, Psychiatry, Antipsychotic AgentsAbstract
Introduction: Bipolar Affective Disorder (BAD) requires pharmacological strategies aimed at preventing relapses and reducing suicide risk. Although lithium is considered the therapeutic gold standard, the marked interindividual variability in treatment response demands a more precise characterization of its comparative advantages over emerging therapeutic alternatives. Methodology: A systematic review based on the PRISMA methodology was conducted. Fourteen high-impact studies indexed in PubMed, Scopus, and Web of Science were identified and analyzed, focusing on therapeutic ranges, comparative effectiveness, and predictive factors associated with lithium response. Results: The findings confirmed the continued relevance of differentiated lithium serum concentrations (0.6–0.8 mmol/L for prophylaxis and up to 1.2 mEq/L during manic episodes), requiring intensive monitoring during treatment initiation and quarterly follow-up during stable phases. Comparatively, olanzapine demonstrated a faster response in acute mania, whereas lithium proved more effective in the global prevention of recurrences and exhibited structural neuroprotective effects not observed with agents such as quetiapine. Clinically, patients presenting a classical bipolar phenotype and a family history of favorable lithium response showed higher remission rates. In contrast, mixed states and polysubstance use were consistently associated with poorer therapeutic response and greater treatment resistance. Discussion: Current evidence supports the combined use of lithium and quetiapine to maximize therapeutic effectiveness in complex clinical profiles. Sertraline monotherapy showed the highest treatment discontinuation rates across all studied populations. Conclusion: Redefining lithium use through the identification of phenotypic and behavioral variables is essential to establish truly individualized and stratified clinical decision-making approaches in BAD.
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Copyright (c) 2026 Paula Milne Morales, José Vargas Brito, Leandro Valecillos Lizardo, Arlet Reinoza Sosa, Tomás Saavedra Poblete (Autor/a)
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