The efficacy of lithium for treating the acute symptoms of mania, as well its use as a mood stabiliser is well established. However, lithium has a narrow therapeutic index and there is potential for fatal toxicity, as well as serious side effects including renal failure. Patient education is important, and psychiatrists need to spend time with their patients prior to starting lithium therapy. A psychiatrist with expert knowledge on lithium is a necessity for safe use of lithium. Unlike other major psychiatric disorders where there are equivalent alternatives, lithium by far is the best treatment for bipolar disorder. All patients with bipolar disorder, unless there are serious contraindications, must be offered the option of taking lithium.