In their editorial "Make lithium great again!" Malhi and collaborators1 reviewed the common misconceptions surrounding tolerability and ease of administration, and the clinical phenotypes to consider when prescribing lithium for bipolar disorders (BD). Despite clinical practice guidelines recommending lithium as a first-line option in BD, its use appears to be declining. For example, in a recent analysis of prescribing practices in the USA between 1997 and 2016, lithium use in outpatients with BD declined from 30% to 18%.2 Given its established efficacy, this is of serious concern. Perhaps the strongest argument promulgated by those who do not prescribe lithium is that only a third of individuals with BD have an excellent prophylactic response.