¹Poznan University of Medical Sciences, Department of Adult Psychiatry, Poznań, Poland

Background: Lithium has been the gold standard for the relapse prevention of mood disorders, especially bipolar disorder (BD). Recently, case reports of a successful lithium prophylaxis lasting half a century appeared. Several adverse effects occur both in the early and late periods of lithium treatment, the most salient being a kidney injury appearing mainly after 15-20 years of lithium administration and frequently prompting lithium discontinuation. At the same time, lithium administration may bring many beneficial outcomes, beyond its prophylactic effects on mood recurrences, among which are anti-suicidal and neuroprotective effects, being the most important.

Aims & Objectives: The presentation aims to consider the pivotal novel findings (published between 2021 and 2025) on the adverse and beneficial effects of long-term lithium administration.

Method: The most important publications on these issues that appeared during this period will be discussed.

Results: The papers on a possible kidney injury during long-term lithium administration and its treatment pointed to a lesser prevalence of such a complication in recent studies, as well as to the possibility of successful management, preventing the necessity of lithium discontinuation. New papers also appeared on the concurrent lithium and hemodialysis treatment in dialyzed patients. The issue of the anti-suicidal effect was confirmed in new meta-analyses, although there were also skeptical publications on this topic. Furthermore, the novel data on the negative association between lithium in drinking water and suicide were provided from such countries as Argentina, Hungary, Iran, and Lithuania. As to the neuroprotective effect of lithium, papers appeared showing a reduction of dementia risk in patients with BD, a condition associated with an increased risk of dementia. Several studies have also demonstrated that lithium administration diminishes all-cause mortality and exerts a favorable effect on many somatic conditions. As BD is associated with an increased risk of osteoporosis, lithium treatment causes a significant decrease in such a risk. Lithium can also reduce the risk of cardiovascular and cerebrovascular (e.g., stroke) conditions, some kinds of cancer, and the incidence of asthma. Regarding the antiviral effects of lithium against herpes viruses, as shown in clinical studies, and against coronavirus, as shown in experimental research, there is evidence that the drug may have a preventive effect against COVID-19. There were also subsequent papers deploring a relative decrease in lithium administration despite favorable data on its effects. They appealed for better education about lithium.

Discussion & Conclusions: During the recent five-year period, novel data emerged on the prevalence and management of kidney complications in lithium-treated patients, as well as about the beneficial outcomes of lithium therapy. The anti-suicidal and neuroprotective effects were confirmed. Furthermore, the evidence of lithium's reduction in all-cause mortality and the morbidity of many somatic conditions has been obtained. There were also claims pointing out that, despite these benefits, there has been a trend of underutilizing lithium in favor of other mood stabilizers, mainly atypical antipsychotics. The voices advocating for increased lithium education, allowing more patients to be beneficiaries of lithium, were raised.