Conclusions Lithium continues as the st and ard and most extensively evaluated treatment for bipolar disorder , especially for long-term prophylaxis
Background Lithium has been used clinical ly for 70 years , mainly to treat bipolar disorder .
Competing treatments and exaggerated impressions about complexity and risks of lithium treatment have led to its declining use in some countries , encouraging this up date about its safe clinical use .
Outcome after rapid vs gradual discontinuation of lithium treatment in bipolar disorders.
OBJECTIVE Withdrawal of bipolar mood disorder ( BP-I ) patients from prolonged , stable lithium maintenance has a high risk of early recurrence , particularly of mania . We thus compared risks of stopping lithium rapidly vs gradually . DESIGN Out patients undergoing clinical ly determined discontinuation of lithium treatment at different rates were followed up prospect ively to 5 years . Risks and timing of new episodes were analyzed . PATIENTS Subjects ( N = 64 ) with a DSM-III-R BP disorder , previously stable on lithium monotherapy for 18 to 120 months ( mean , 3.6 years ) were followed up clinical ly after discontinuing lithium ( elected in prolonged wellbeing in 67 % ) . None was unavailable for follow-up , and subtyping ( BP-I or BP-II ) remained stable . RESULTS Within 5 years , 75 % had a recurrent episode ; BP-I patients were 1.5-times less likely than BP-II to remain in remission . Polarity of first-recurrent and onset episodes was 80.8 % concordant . Overall risk of a new episode of mania was significantly greater after rapid ( < 2 ) than gradual ( 2 to 4 weeks discontinuation ( 5-year hazard ratio = 2.8 ) ; the difference in risk of depression was even greater hazard ratio = 5.4 ) . Recurrence rate was more elevated within months of rapid discontinuation ( 12-month hazard ratio = 5.4 ) . Recurrence rate was more elevated within months of rapid discontinuation ( 12-month hazard ratio = 4.3 ) than at later times ( 2 to 5 years ) , when courses of " survival " over time were nearly parallel in both discontinuation groups . CONCLUSIONS Risk of early recurrence of BP disorder following discontinuation of lithium maintenance is elevated , but may be both predictable ( timing and polarity ) and modifiable by gradual discontinuation
Conclusions Lithium continues as the st and ard and most extensively evaluated treatment for bipolar disorder , especially for long-term prophylaxis
Background Lithium has been used clinical ly for 70 years , mainly to treat bipolar disorder .
Competing treatments and exaggerated impressions about complexity and risks of lithium treatment have led to its declining use in some countries , encouraging this up date about its safe clinical use .