The editorial by Malhi et al¹ is a timely and most welcome wake‐up call regarding the declining use of lithium in the long‐term maintenance treatment of bipolar disorders. In support of the issues discussed, we would like to stress several topics which we believe can further help to make a better life for as many patients with bipolar disorders as possible.

Given its long‐term effectiveness as evidenced in randomized controlled studies as well as in naturalistic observational studies,² lithium is the gold standard in the maintenance treatment of bipolar disorders. When used properly, lithium can bring about dramatic improvements in the course of this disease, with, in general, good tolerability, also in comparison with other approved treatment options. However, it is not a panacea for every individual patient at every stage of the disease. There is a significant number of patients who do not respond to or do not tolerate the usually recommended therapeutic serum concentrations of 0.6–0.8 mmol/L³.

Given its potential toxicity, lithium is a drug for the informed cooperating patient, who has developed an acceptance regarding his illness and the need for long‐term medication and regular check‐ups. As suggested by Malhi et al,¹ high‐quality group psychoeducation may greatly help for the majority of patients for successful long‐term treatment with lithium based on “shared decision making” with an openness to flexible patient‐centered solutions with regard to dosage issues, side‐effect management,⁴ and stand‐by add‐on/combination treatment.

Under the above conditions, lithium should be offered and recommended to every patient with bipolar disorders early in the course of the disease as the mainstay of long‐term treatment. Against this background, lithium should also be used more often in the acute treatment of manic episodes, if needed in combination with other mood‐stabilizing drugs that are approved for this purpose and may have a more rapid onset of action, in order to facilitate the path to successful long‐term treatment with lithium.

Do we still need "better" drugs for treating bipolar disorders⁵? Of course we do! Until then, however, we should use lithium, the best currently available treatment option we have for treating bipolar disorders, much more frequently—corresponding to the available scientific evidence.

Malhi等人¹的社论是关于锂在双相性精神障碍的长期维持治疗中使用量下降的及时且最令人欢迎的警钟。为了支持所讨论的问题，我们想强调几个主题，我们认为这些主题可以进一步帮助尽可能多的双相情感障碍患者改善生活。

鉴于其长期有效性在随机对照研究和自然观察研究中得到证明，²锂是维持双相情感障碍的金标准。如果正确使用锂，与其他批准的治疗方案相比，锂可以在这种疾病的发生过程中带来显着的改善，通常具有良好的耐受性。但是，它并不是每个病人在疾病各个阶段的灵丹妙药。有很多患者对通常推荐的治疗性血清浓度0.6-0.8 mmol / L ³无反应或不耐受。

由于锂具有潜在的毒性，因此它是一种针对知情合作患者的药物，该患者对其病情以及是否需要长期用药和定期检查已形成了接受。正如Malhi等人的建议，¹高质量的团体心理教育可能对大多数患者基于“共同决策”的锂长期成功治疗有很大帮助，并且在剂量问题上对以患者为中心的灵活解决方案持开放态度，副作用管理，⁴和备用附加/组合治疗。

在上述情况下，应向每位患有双相情感障碍的患者提供锂，并建议其在病程早期作为长期治疗的主要手段。在这种背景下，如果需要，可将锂更频繁地用于躁狂发作的急性治疗中，并与其他已获批准用于此目的且可能起效较快的情绪稳定药物联合使用，以利于锂长期成功治疗的途径。

我们是否仍需要“更好的”药物来治疗躁郁症⁵？当然可以！但是，在那之前，我们应该更频繁地使用锂，这是目前治疗双相情感障碍的最佳方法，这与现有的科学证据相对应。