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In general, if you read any textbook of psychiatry, it will tell you lithium is the top choice for bipolar. Depakote ties lithium for 1st place. Both require careful blood monitoring. With lithium you have to stay well hydrated too.
Even though it's a good drug for bipolar in general, every patient's response will vary. Many of my patients have loved lithium....and many didn't like it all. It may or may not help the voices. I prescribe more lithium than abilify for sure.
The general rule of thumb is to start with a low dose and don't increase the dose too quickly. I usually start people on 300mg 2-3X/day. In patients who are very sensitive to side effects I start them on 150-300mg once/day. I try to not increase the dose much earlier than 1-4 weeks depending on the person. I prescribe a little more aggressively if the patient is hospitalized because I can monitor more closely.
I hope this helps. Take care.
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