When deciding whether to use lithium in a person with a bipolar disorder, we should systematically look for the following TEN factors in the Past, Present, and Future:
1. Adult (rather than an adolescent)
2. Later age of onset
3. Less than three prior episodes. (The problem is that many clinicians will try other treatments first and start lithium only after many episodes have already occurred.)
4. Mania-Depression-Interval pattern of episodes. (Mania followed by depression followed by a euthymic interval. As opposed to depression followed by mania.)
5. Fewer hospitalizations
6. Absence of rapid cycling (four or more episodes per year).
7. Good response to lithium in a first-degree relative
8. Classical mania (with only euphoria rather than with mixed features)
9. Absence of comorbid substance abuse
10. And, most important of all, the person takes the lithium and does not have unacceptable adverse effects.