18 June 2025
An interdisciplinary research team led by the Department of Psychiatry, School of Clinical Medicine, LKS Faculty of Medicine of the University of Hong Kong (HKUMed) has conducted Hong Kong's first study analysing 16 years of data to confirm the safety of lithium treatment for bipolar disorder. The findings, published in JAMA Network Open [link to the publication], reveal that while patients receiving lithium treatment exhibit a slightly higher rate of thyroid and kidney dysfunction than non-users, the overall incidence remains low.
Despite being internationally recommended as a first-line mood stabiliser treatment, which is highly effective in managing mood episodes and reducing suicide risk, lithium remains underutilised in clinical practice. This study reinforces its therapeutic value, showing that with regular monitoring, lithium can be safely used to manage bipolar disorder. The research team also highlighted the importance of public education in mental health, encouraging patients to seek professional help with a positive and proactive attitude.
‘Our findings support clinical guidelines recommending lithium as a first-line therapy for bipolar disorder,’ said Dr Chang Wing-chung, Chairperson and Clinical Associate Professor in the Department of Psychiatry, School of Clinical Medicine, HKUMed. ‘With regular blood monitoring, abnormal function can be detected early and managed effectively, allowing patients to benefit safely from its proven advantages.’
The current findings show that the majority of patients treated with lithium do not develop thyroid or kidney dysfunction, reinforcing its safety when used under appropriate clinical oversight. Looking ahead, the study also underscores the potential of AI-based risk prediction tools to enhance patient safety [link to the publication]. By analysing patient data, these emerging techniques may help identify lithium users at higher risk of developing complications during treatment. In line with this vision, the HKUMed research team is developing a series of AI-based risk screening tools that can generate individualised health risk scores for patients receiving mental health care. This will enable a future of more informed treatment decisions and contribute to the gradual advancement of personalised, preventive approaches in mental health care.
Dr Chang emphasised, ‘With proper monitoring, patients can confidently receive mental health treatment supported by strong evidence, such as utilising lithium as the first-line mood stabiliser for bipolar disorder.’ He and the research team also stressed the importance of public education in dispelling stigma and misinformation surrounding mental health treatments, encouraging individuals to seek professional care without hesitation.
‘Case studies have always been the cornerstone of our learning as doctors, offering valuable insights and medical lessons,’ said Dr Chang. ‘Today, AI and big data present us with unprecedented opportunities. While these may appear to be just numbers, to healthcare professionals, every data point represents a real-life story—a patient in need.’
Dr Chang highlighted the current challenge of transforming real-life stories into meaningful insights. ‘By integrating clinical experience with machine-learning techniques and leveraging the high-quality big data provided by the Hospital Authority, the research team is actively converting these case documents into actionable medical recommendations and strategies,’ he said. Looking ahead, the research team envisions big data becoming an essential tool for improving mental health care in Hong Kong, enabling future healthcare providers to offer more precise and personalised support to patients.
About the research team
The study was led by Dr Chang Wing-chung, Chairperson and Clinical Associate Professor, Department of Psychiatry, School of Clinical Medicine, HKUMed. The first author was Dr Joe Chan Kwun-nam, Postdoctoral Research Fellow in the same department. Other research team members from HKUMed included Dr Heidi Lo Ka-ying, Clinical Assistant Professor from the same department; Dr Corine Wong Sau-man, Research Assistant Professor from the School of Public Health; Professor Francisco Lai Tsz-tsun, Assistant Professor from the Department of Pharmacology and Pharmacy; and other world-renowned scholars from overseas.
| Research methods and findings Lithium is widely recognised as the most effective mood stabiliser for bipolar disorder, with substantial evidence supporting its superior efficacy in reducing recurrence, readmission and self-harm. However, concerns about potential thyroid and kidney dysfunction have limited its use. To investigate these risks, the research team analysed electronic medical records and lab results from the Hospital Authority, covering the period from 2002 to 2018 with follow-up assessments. The study included data from over 4,500 patients to assess thyroid outcomes and 7,000 patients to assess kidney outcomes. The research assessed the risk of conditions such as thyroid function abnormalities, chronic kidney disease (stage 3 or above) and end-stage kidney disease. Statistical models were used to account for other potential risk factors to ensure accurate and reliable calculations. The key findings were as follows:
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