Lithium carbonate is indicated for both acute mania and maintenance therapy in bipolar disorder. It also has utility in some cases of major depression (both unipolar and bipolar) and in some disorders characterized by episodic explosive outbursts or self-mutilation. Its mechanism of action is not exactly known, although it may relate to reducing dopaminergic function, enhancing serotonergic function, or reducing "excessive signaling" by the phosphytidylinositol system. The extensive pretreatment evaluation and long latency of action preclude the use of lithium as an emergency psychotropic medication. The emergency physician should be aware, however, of its side effects and signs of toxicity.

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