Subjects fulfilling DSM 5 criteria of Bipolar I disorder with onset before 18 years on Lithium prophylaxis were included. A total of 575 subjects with Bipolar Disorder were screened, 141 had early-onset Bipolar disorder, 72 patients were on Lithium and 52 provided informed consent and entered the study. Thirty-four were in the prospective group, and 18 were in the retrospective arm. Mean age at onset was 16.13 (1.40) years. About 31% (n = 16) were initiated on Lithium following first episode. Mean age at initiating lithium was 19.73 (3.82) years. Clinical profile and treatment response of early-onset bipolar disorder in the Indian context needs further study.