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Lithium can treat acute mania and help prevent both manic and depressive relapses, reducing the likelihood of hospitalization. It may also reduce suicide risk and serve as augmentation in treatment-resistant major depression. Its predictable renal elimination and lack of hepatic metabolism contribute to a relatively low burden of CYP interactions, while generic availability supports its low cost. These benefits must be balanced against a narrow therapeutic index and risks that include neurologic, gastrointestinal, renal, thyroid, and cardiac effects. Pregnancy-related cardiac risks, interactions that raise serum concentrations, and a slow onset of action also affect treatment decisions. Safe use depends on assessing suitability, monitoring serum levels and relevant organ function, and avoiding abrupt discontinuation.