Lithium is still the first choice for bipolar disorder prophylaxis, preventing manic and depressive episodes from returning. The longitudinal effects of administering lithium far outweigh those of other mood stabilizers. The kidney, gastrointestinal, neurological, thyroid, metabolic, cognitive, dermatological, cardiovascular and sexual side effects of lithium is all listed. Interstitial nephropathy is probably the most serious side effect of lithium, usually seen after 10 to 20 years of use. Long-term lithium therapy also has beneficial side effects, such as anti-suicidal, antiviral and anti-dementia effects. Long-term lithium treatment may be affected by pharmacokinetic and pharmacodynamics interactions, mostly with other drugs. The narrative review of lithium-induced side effects and interactions that may affect its prophylactic effect in bipolar disorder is updated in this paper. They are described, along with their mechanisms and management strategies. They also share their own observations regarding the ultra-long lithium treatment of bipolar disorder patients. The review may assist psychiatrists in providing bipolar patients with a successful lithium prophylaxis.
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