Psychopharmacology and Psychiatry Updates Beyond Antipsychotics: Using Lithium in Mania
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Nov 12, 2025 
Dr. David Osser, an Associate Professor of Psychiatry at Harvard Medical School and expert in bipolar treatment, argues for lithium as the first-line therapy for classic mania. He presents compelling evidence of lithium's neuroprotective benefits and long-term efficacy, emphasizing its role in reducing suicide risk and preventing episodes. Comparisons of second-generation antipsychotics reveal their limited advantages over lithium. Osser’s insights challenge the reliance on antipsychotics, advocating for lithium's unique advantages in managing bipolar disorder.
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Choose Lithium First For Classic Mania
- Use lithium as first-line treatment for acute classic mania when possible.
- Prioritize medications that also prevent future manic and depressive episodes, like lithium.
Lithium's Unique Disease-Modifying Role
- Lithium uniquely combines acute antimanic efficacy with FDA-approved maintenance efficacy for mania and depression.
- It also shows neuroprotective effects that can slow or reverse cortical gray matter loss.
Lithium Lowers Suicide And Self-Harm
- Lithium reduces suicide risk better than other bipolar medications.
- Studies show lower rates of self-harm and unintentional injury with lithium versus valproate and some antipsychotics.