Case ReportsLithium Use During Pregnancy in a Patient With Bipolar Disorder and Multiple SclerosisLorettu, Liliana MD∗; Carpita, Barbara MD†; Nivoli, Alessandra MD∗; Milia, Paolo MD, PhD∗; De Iorio, Giovanni MD†; Cremone, Ivan Mirko MD†; Dell'Osso, Liliana MD†Author Information ∗Clinica Psichiatrica-Dipartimento di Scienze Mediche Chirurgiche e Sperimentali, Università degli Studi di Sassari-AOU Sassari, Sassari †Dipartimento di Medicina Clinica e Sperimentale, Università di Pisa, Pisa, Italy. Address correspondence and reprint requests to Barbara Carpita, MD, Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, 56127 Pisa, Italy; E-mail: firstname.lastname@example.org Conflicts of Interest and Source of Funding: The authors have no conflicts of interest to declare. Clinical Neuropharmacology: 9/10 2020 - Volume 43 - Issue 5 - p 158-161 doi: 10.1097/WNF.0000000000000407 Buy Metrics Abstract Although lithium is widely used as a first-line treatment for mood disorders, its mood-stabilizing effects remain not fully understood. A growing body of data are stressing that lithium seems to show broader properties, including neuroprotective effects. Lithium's ability to inhibit glycogen synthase kinase 3β, an enzyme that participates in the phosphorylation of τ, a microtubule-associated protein, stimulated interest in its possible therapeutic role in Alzheimer disease and other neurodegenerative disorders. Preliminary data also support exploration of lithium's potential therapeutic role in multiple sclerosis, an autoimmune disorder that is associated with co-occurring mood disorders. Lithium is associated with teratogenic risks to the developing fetus; however, recently revised downward estimates of its teratogenic risk of causing fetal cardiac malformation suggest that its potential therapeutic benefit to both mothers with bipolar disorder and their offspring should be considered in at least some cases. A 43-year-old woman previously diagnosed with bipolar disorder and MS was treated with lithium and thyroid hormone supplementation as her sole medications during her pregnancy. The patient remained euthymic throughout her pregnancy and over the course of her 5-year follow-up evaluations on this medication regimen. In addition to her stable mood, there has been no symptomatic progression or relapse of her MS, and her daughter continues to develop normally. The case supports consideration of balancing lithium's mood-stabilizing benefit with its known teratogenic risk during pregnancy. The case also supports exploration of possible additional benefit in the context of MS co-occurring with bipolar disorder. Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.