Lithium as a first-step option for acute phase pharmacotherapy of bipolar depression

A recently published summary of the 2020 clinical practice guidelines from the Royal Australian and New Zealand College of Psychiatrists provides recommendations on management of bipolar disorder (1). The acute phase pharmacotherapy of a depressive episode in patients with bipolar disorder, in the following referred to as treatment of bipolar depression, is especially challenging. The evidence for lithium as a treatment of bipolar depression is limited and conflicting (2), and therefore the positioning of this drug for the treatment of bipolar depression in upcoming guidelines is of particular interest.