Lithium monotherapy for high-risk bipolar patients may require near-toxic doses.

“so usually a patient with bipolar disorder is treated with several drugs but in some cases some of the drugs either the patient's don't respond they're recalcitrant to the drug or they produce such negative side effects they can drive up you know suicidal ideation things like that that you basically have to resort to just lithium and now that's our really scary that's about as scary a case as a psychiatrist can be in because you basically have to put enough lithium in that patient to take them almost to a toxic dose without pushing them over”