Strengths:
- 'Gold standard' of mood-stabilizing drugs
- Well-documented efficacy in acute mania and maintenance (less so for bipolar depression)
- Documented antisuicidal effects
- Has been used for more than 50 years
- Inexpensive
Weaknesses:
- Narrow therapeutic index
- Difficult to use (monitoring of plasma concentration is required)
- Poor tolerability profile
- Poor compliance which may lead to premature relapse
- Predominantly effective against manic relapse
GSK counterclaim:
Lithium is less effective in treating depression compared with mania (Calabrese JR et al. and Bowden CH et al.).