Licensed as a psychiatric nurse practitioner more than 20 years ago, I thought I’d never need or want to prescribe lithium. Old school, I thought. A 1950s drug; we have much better now.

It’s true, lithium was known for ghastly side effects; lots of them, and bad: thyroid and kidney disorders, brain fog, tremors, GI issues, weight gain, and more. No way would I submit patients—many of whom were women seeking pregnancy—to those.

Much more salient today, lithium’s negative effects are, like most drugs, dose-dependent: The higher your dosage, the more likely you are to suffer side effects. Keep doses low, and mild to no side effects appear.

And due to two things—(1) side effects being dose-dependent and (2) the advent of newer meds used in conjunction with lower lithium—prescribing changed dramatically. There are multiple contexts in which lithium outdoes any other mood stabilizer, especially in

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