Perspectives on the use of lithium as a therapeutic option for bipolar disorder in 2026

INTRODUCTION: There is a disconnect between the designation of lithium (Li) as the drug of choice for bipolar disorder and its use in only a small minority of patients. Low use is seen especially in the US where less than 20% of bipolar patients are on Li. AREAS COVERED: The literature and prevailing medical and popular opinion tend to overemphasize lithium's side effects and minimize many of its assets. In this review, the author reviews some of these misconceptions and in addition emphasizes new data that Li should be considered a disease-modifying drug (DMD). Like DMDs for other medical illnesses, these agents should be used early in the illness to prevent disease progression and disability. EXPERT OPINION: Presently, Li is rarely used early on in illness and is negligibly used in children. Nevertheless, it is with hope that perspectives on Li like these will help to drive increased and appropriate use in bipolar disorder. That said, it is of this author's opinion that, without major new educational and public health approaches, there is unlikely to be any change in usage, at least in l the near future.