Bipolar disorder (BD) affects more than 3% of the worldwide population.1–3 People with BD experience episodes of mania and depression that often repeat periodically.4,5 About 50% of BD patients suffer from hallucinations or delusions.6,7 Left untreated, patients are at a high risk of suicide.8,9 The main current treatment for BD is chronic lithium (Li) therapy.10,11 Li is known to act through an inhibition of glycogen synthase kinase-3β,12 modulation of the neurotransmitters and signals impacting the cytoskeleton,13 an increase in neurotrophic molecules, changes in the metabolic enzymes and signaling pathways involved in the antioxidant response, apoptosis and endoplasmic reticulum stress.14–16 However, the exact mechanism of how Li stabilizes mood is not completely understood. Only ~ 30% of BD patients respond fully to Li (LR);17,18 in this study, half of our patients were Li-non-responders (NR).
