Vincenzo Oliva, with Allan H. Young, and Eduard Vieta et al (2025) wrote: “Patterns of lithium exposure and mortality in bipolar disorder: a population-based cohort study“ in Cambridge University Press based on 15,384 patients in Catalonia, Spain (2010–2019).   

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They found that continuous lithium treatment was better in extending life expectancy than either intermittent treatment or no lithium treatment, which did not differ from each other.

Post et al previously reported a series of more than a dozen patients that good responders to lithium who stopped treatment did not re-respond to lithium when it was reinstated. This has remained controversial as many authors claim there is no such thing as what we labeled as lithium discontinued-induced non responsiveness. I have seen these individuals and they all regret that they ever stopped their treatment.

The study of Oliva et al (2025) takes these findings to a new level. Lithium decreases all-cause mortality. Intermittent lithium use does not. When early mortality is used as the unequivocal measure of a poor outcome, intermittent use of lithium proves useless. Continuous lithium treatment extends longevity.

Editors Note: Patients and clinicians should know that occasional stopping of lithium treatment in good responders carries severe risks. One is the possibility that in about 10 to 15% of patients, they will fail to respond as well as before, and in some patients, they will not only not respond to lithium as well as before, but will not respond to most other treatments as well. The new data in 15,384 patients extends these risks of intermittent use of lithium to a new level—early demise.

The message seems clear. If you are on lithium and doing well, your life and longevity may depend on staying on lithium continuously. Intermittently stopping lithium conveys grave risks.