I was pleased to read the analysis by Baldessarini and Tondo1 indicating that, contrary to some reports, lithium has not lost its efficacy as a treatment for bipolar disorder in recent years. Certainly their findings are in accord with my own clinical experience that lithium is effective and well tolerated, especially at moderate serum lithium concentrations, as they note in their report.
One factor that may be responsible for lithium's fall from grace among clinicians and patients is its status as an "orphan" or "poor relative." Since lithium is cheap and unpatented, no wealthy drug company has any interest in demonstrating its merits as a mood stabilizer. There are no lavishly catered all-star symposia at major psychiatric meetings to sing the praises of this humble salt. And when did you last see a pen, notepad, calendar, or trinket with "Lithium" embossed on it? Finally, lithium is regarded as old news and, as such, is less appealing to psychiatric researchers eager to make their mark on the field.