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 .
Methodological problems of prophylactic trials in recurrent affective disorders.
Design s used with success in therapeutic experiments are not necessarily suited to prophylactic trials , which offer special problems and require that new experimental procedures and statistical methods are employed . Controlled prophylactic trials may be carried out in two different ways : ( i ) Concurrent comparison of the course of the disease in an experimental patient group and a control group , and ( ii ) studies on a single group of  patients during successive control periods and drug periods . Each procedure offers advantages and disadvantages ; ethical problems are of particular importance . Special attention should be given to the definition of patient sample s and to the criteria chosen for recording a relapse . Experiments must be design ed with consideration of the role played by non-pharmacological factors : spontaneous variation of the disease course during treatment , the psychological effects of the treatment , and observer bias
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 .