The recent study by Aron et al about lithium deficiency and the onset of Alzheimer’s disease provides a valuable explanatory framework for understanding how very small doses of lithium, delivered via environmental exposure, can exert neuroprotective effects. It also contains results which will need to be reconciled with foundational chemistry and existing evidence and which could be potentially misleading. The suggestion that lithium orotate (LiO) exhibits benefits relative to the more traditionally used lithium carbonate (LiC) requires further scrutiny in light of the following arguments: (a) no study has demonstrated the presence of stable LiO in physiological fluids; (b) acid–base chemistry predicts that LiO will be largely protonated in the stomach, causing it to dissociate and be absorbed as Li+; (c) experimental studies indicate that LiO and LiC have comparable pharmacokinetics after oral administration; and (d) previous research has shown that LiC also has neuroprotective effects, including at very low doses. Disproportionate focus on a specific lithium salt could have safety implications and may distract from answering fundamental questions about the effects of very low doses of lithium. More experiments are needed to provide evidence of a stable LiO complex in physiological fluids before this becomes the main form of lithium in future clinical trials.

Cognitive impairment is a major determinant of disability in bipolar disorder (BD) and a defining feature of both mild cognitive impairment (MCI) and Alzheimer’s disease (AD). Lithium, a first-line maintenance treatment for BD, is implicated in neuroprotective mechanisms including glycogen synthase kinase-3β inhibition, amyloid and tau modulation, and neurogenesis promotion. The overarching aim of this systematic review is to evaluate the long-term effects of lithium on cognition across BD, MCI, and early-to-moderate AD using randomized controlled trial (RCT) evidence. Online databases were searched from inception through May 2025 for RCTs reporting lithium’s effect on cognitive outcomes in BD, MCI, or early-to-moderate AD with ≥8 weeks of follow-up. Risk of bias was assessed using the Cochrane RoB 2 tool. Eight RCTs met the inclusion criteria, ranging from 10 weeks to 3 years in duration. Across four BD trials, lithium did not exhibit consistent improvement or worsening on composite cognitive scores. Three of four MCI/AD trials reported attenuated global cognitive deterioration with low-dose lithium, especially when exposure was ≥12 months. Methodological limitations included small sample sizes, exploratory endpoints, and variable measures for cognitive function as well as lithium strategies. Lithium demonstrates preliminary signals of slower cognitive decline in MCI/AD. Available evidence suggests lithium has neutral effects on cognitive impairment in BD. Future adequately powered RCTs with cognition as a primary endpoint, functional measures, and biomarker outcomes are warranted to clarify lithium’s role as a maintenance treatment in psychiatric disorders and its potential neuroprotective effects in neurodegenerative diseases.

Long-term pharmacological augmentation is central to care for treatment-resistant depression, yet until recently no adequately powered trials have examined it. With three such studies now published, we highlight the hope they offer for improving outcomes in this underserved population while highlighting caution in interpreting their collective findings without careful consideration of methodology and clinical context. We consider these issues and their implications for guiding more personalised treatment decisions aimed at sustained benefit in routine practice.

Lithium is the only true mood stabiliser as it is able to both treat and prevent mania and depression. In practice, its popularity has declined despite discovering it has anti-suicidal and neuroprotective properties. Here, we argue for recognition of its benefits and advocate for its clinical use more widely.

Mannitol (C6H14O6) is a soluble sugar-alcohol that chelates alkali metals and is commonly used to remove adsorbed boron from mineral surfaces before isotopic analysis. Boron (B) and lithium (Li) are both light incompatible elements that substitute in clay minerals; therefore, the potential for mannitol to extract surface adsorbed Li was studied. Lithium was adsorbed on <2 μm kaolinite (KGa-1) and smectite (SWy-1) clays, and on <20 μm quartz, from 1.0 M LiCl and LiOH solutions. Differences in surface attraction for Li+ result from the mineral point of zero charge (PZC) and solution pH. Various concentrations of mannitol (0.1 M, 0.5 M, 1.0 M) were tested for Li-extraction. Efficient Li-extraction requires mannitol concentrations approximating molar amounts of adsorbed Li. Mannitol molecules (>5 nm) cannot enter clay interlayers easily, but nonetheless extracted large amounts of soluble interlayer Li. Smectite adsorbed the most Li (2.2 wt.%) from LiOH, and >99% of it was removed using 0.5 M mannitol at 25°C in 24 h. Lithium bound in the interlayers can then be retrieved for isotopic analysis using NH4Cl cation exchange. This methodological framework for isolating different reservoirs of Li in clay provides a tool for tracking fluid δ7Li evolution during clay alteration. It opens new possibilities for evaluating fluid δ7Li evolution in asteroidal clays. Structural Li records fluid δ7Li at temperatures of neoformation, while interlayer-bound Li preserves the δ7Li of most recent fluids. Overall, this study demonstrates that mannitol is an efficient and environmentally benign alternative to harsh acid extractions for ore-grade Li adsorbed in clays.

We consider that the current National Institute for Health and Care Excellence (NICE) guideline CG185 on bipolar disorder does not provide sufficiently specific guidance for the safe monitoring of plasma lithium levels in older people. We feel this needs correction, and laboratories across the UK should lower the range recommended for monitoring older people’s lithium levels in line with guidelines from the International Society for Bipolar Disorder. This would provide a safety net in older people in order to prevent lithium toxicity without compromising efficacy.

The global energy transition carries significant geopolitical implications. This study examines how Chinese exports of critical electrical goods and geopolitical risk influence national energy transitions, focusing on lithium and rare earth production, pricing and oil markets. Using a Global Vector Autoregressive model across 12 major economies (2012–2019), with emphasis on Australia, China and the United States, the analysis shows that Chinese geopolitical risk affects the consumption of electrical goods, renewable energy deployment and critical mineral production. Empirical findings reveal that reliance on Chinese electrical goods creates strategic dependencies, making other countries vulnerable to shifts in China’s energy strategy. While oil prices are less relevant for most economies’ transitions, they remain central to the United States. The results highlight both the geopolitical risks and cooperative potential embedded in the global shift to clean energy.

Since the 1980s, state capacity has been a major explanation for countries leaving the middle-income trap. However, this literature is unable to explain the failed experiences of countries with relatively high state capacity. This was the case of Chile after the unsuccessful enaction of a series of policies in the mid-2010s to upgrade the country’s position in the lithium value chain. To understand this failure, we combine the literature on developmental states and the literature on business power. We use the concept of institutional business power to understand how business actions erode state capacities leading to countries’ persistent inability to leave the middle-income trap. In the case of Chile, despite the relatively high levels of state capacity, previous processes of deregulation and privatization in the country configured a situation favorable to business’ monopolization of information and technical knowledge about lithium production and innovation processes that directly affected the capacity of the state to regulate the sector, let alone implement policies designed to upgrade the industry. The article highlights the need to investigate further the role of not just the state, but of the private sector in either facilitating or blocking value chain upgrading in countries caught in the middle-income trap.

The scramble to extract critical energy transition minerals creates risk of widespread negative human rights impacts. A just transition in the extraction of critical minerals must involve deep examination of the mine-community interface to gain a better understanding of the drivers of successful engagement between mining companies and communities. Drawing on fieldwork in South America’s lithium triangle, this paper finds that the nature of the corporate-community relationship is increasingly key to enabling a just transition whereby communities participate in the benefits of extraction with negative impacts mitigated. It establishes that key success factors are related to empowerment of Indigenous communities and have the potential to maximise positive outcomes for communities in the context of lithium extraction. Governments and companies must embed a more bottom-up process with an end goal of communities themselves defining the parameters of what a just transition means in the critical minerals context.