In Wilson's disease (WD) presenting with mania or bipolar disorder, lithium carbonate is established as the recommended first-line treatment. When it cannot reach target serum levels or fails to control manic symptoms, a structured next-line approach is needed.
Treatment with lithium carbonate (first line) did not achieve:
Lithium is preferred initially in Wilson's disease because it is renally excreted and not metabolised by the liver — a critical consideration given the hepatic involvement in WD. When it fails, alternatives must be selected with similar care.
Second-line management draws on a group of mood stabilisers and antipsychotics that have been evaluated in the context of Wilson's disease. The clinical goal is improvement and resolution of manic symptoms.
The specific agents, their sequencing, and the clinical considerations that guide selection are covered in the full structured protocol.
DOI: 10.1016/j.jhep.2024.11.007