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The Efficacy of Lithium in Prophylaxis of Unipolar Depression Evidence from its Discontinuation

Published online by Cambridge University Press:  02 January 2018

F. G. M. Souza ,
A. J. Mander  and
G. M. Goodwin
F. G. M. Souza
Affiliation:
Edinburgh University Department of Psychiatry, State University of Ceara, Messejana Mental Hospital, Fortaleza, Brazil
A. J. Mander
Affiliation:
Royal Park Hospital, Melbourne, Australia, formerly Lecturer, University Department of Psychiatry, Royal Edinburgh Hospital, Edinburgh
G. M. Goodwin*
Affiliation:
MRC Brain Metabolism Unit, Royal Edinburgh Hospital, Edinburgh
*
∗MRC Brain Metabolism Unit, Kennedy Tower, Royal Edinburgh Hospital, Morningside Park, Edinburgh EH10 5HF
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Abstract

Forty unipolar patients satisfying DSM–III criteria for major depression who discontinued lithium therapy were retrospectively compared with 105 similar patients who continued the drug and served as a control group. The time to readmission from starting lithium was compared while both groups were still on lithium, and after discontinuation in one group and further continuation in the control group. The progressive increase in the probability of recurrence over two years was the greatest after discontinuation of lithium. For the patients who eventually discontinued lithium, the cumulative probability of recurrence in two years was 0.08 on lithium and 0.58 after stopping it. The probability of recurrence was unchanged over the duration of the study for patients who continued to take lithium. There was no evidence of a lithium withdrawal syndrome within three months of stopping the drug. The results support the view that the everyday clinical use of lithium as prophylaxis is beneficial in unipolar depression.

Type
Papers
Information
The British Journal of Psychiatry , Volume 157 , Issue 5 , November 1990 , pp. 718 - 722
Copyright
Copyright © The Royal College of Psychiatrists 

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References

American Psychiatric Association (1980) Diagnostic and Statistical Manual of Mental Disorders (3rd edn) (DSM–III). Washington, DC: APA.Google Scholar
Baastrup, P. C. & Schou, M. (1967) Lithium as a prophylactic agent. Its effect against recurrent depression and manic-depressive psychosis. Archives of General Psychiatry, 16, 162–172.Google Scholar
Bouman, T. K., Niemantsuer Driet-Van Kampen, J. G., Ormel, J., et al (1986) The effectiveness of lithium prophylaxis in bipolar and unipolar depressions and schizoaffective disorders. Journal of Affective Disorders, 11, 275–280.Google Scholar
Carroll, B. J. (1979) Prediction of treatment outcome with lithium. Archives of General Psychiatry, 36, 870–878.CrossRefGoogle ScholarPubMed
Coppen, A., Montgomery, S. A., Gupta, R. K., et al (1976) A double-blind comparison of lithium carbonate and maprotiline in the prophylaxis of affective disorders. British Journal of Psychiatry, 128, 479–485.Google Scholar
Coppen, A., Ghose, K., Rao, R., et al (1978) Mianserin and lithium in prophylaxis of depression. British Journal of Psychiatry, 133, 206–210.Google Scholar
Davis, J. M. & Farm, J. E. (1971) Lithium. Annual Review of Pharmacology, 11, 285–302.Google Scholar
Fieve, R. R., Platman, S. R. & Plutnick, R. R. (1968) The use of lithium in affective disorders: I. Acute endogenous depression. American Journal of Psychiatry, 125, 487–491.Google Scholar
Fleiss, J. L., Dunner, D. L., Stallone, F., et al (1976) The life table: a method of analysing longitudinal studies. Archives of General Psychiatry, 33, 107–112.Google Scholar
Glen, A., Johnson, L. & Shepherd, M. (1984) Continuation therapy with lithium and amitriptyline in unipolar depressive illness: a randomised double-blind controlled trial. Psychological Medicine, 14, 37–50.Google Scholar
Goodwin, F. K., Murphy, D. L. A. Bunney, W. E. Jr (1969) Lithium carbonate treatment in depression and mania: a longitudinal double-blind study. Archives of General Psychiatry, 21, 486–496.Google Scholar
Goodwin, F. K., Murphy, D. L., Dunner, D. L., et al (1972) Lithium response in unipolar versus bipolar depression. American Journal of Psychiatry, 129, 44–47.Google Scholar
Grof, P., Schou, M., Angst, J., et al (1970) Lithium prophylaxis in recurrent affective disorders. British Journal of Psychiatry, 116, 604–619.Google Scholar
Johnson, G. (1974) Antidepressant effect of lithium. Comprehensive Psychiatry, 15, 43–47.Google Scholar
Kane, J. M., Quitkin, F. M., Rifkin, A., et al (1982) Lithium carbonate and imipramine in the prophylaxis of unipolar and bipolar II illness. A prospective placebo-controlled comparison. Archives of General Psychiatry, 39, 1065–1069.Google Scholar
Khan, M. C. (1981) Lithium carbonate in the treatment of acute depressive illness. Bibliotheca Psychiatrica, 161, 244–248.Google Scholar
Lewis, J. L. & Winokur, G. (1982) The induction of mania. A natural history study with controls. Archives of General Psychiatry, 38, 303–330.Google Scholar
Mander, A. J. (1986) Is there a lithium withdrawal syndrome? British Journal of Psychiatry, 149, 498–501.Google Scholar
Mander, A. J. & Loudon, J. B. (1988) Rapid recurrence of mania following abrupt discontinuation of lithium. Lancet, ii, 15–17.Google Scholar
Noyes, R. Jr (1969) Lithium carbonate. Diseases of the Nervous System, 30, 318–321.Google Scholar
Peselow, E. D., Dunner, D. L., Fieve, R. R., et al (1982) Lithium prophylaxis of depression in unipolar, bipolar II and cyclothymic patients. American Journal of Psychiatry, 139, 747–752.Google Scholar
Prien, R. F., Klett, J. & Caffey, E. M. (1973) Lithium carbonate and imipramine in prevention of affective episodes. Archives of General Psychiatry, 29, 420–425.Google Scholar
Prien, R. F., Kupfer, D. J., Mansky, P. A., et al (1984) Drug therapy in the prevention of recurrences in unipolar and bipolar affective disorders. Archives of General Psychiatry, 41, 1096–1104.Google Scholar
Sashidharan, S. P. & McGuire, R. J. (1983) Recurrence of affective illness after withdrawal of long term lithium treatment. Acta Psychiatrica Scandinavica, 68, 126–133.Google Scholar
Schou, M. (1979) Lithium as a prophylactic agent in unipolar affective illness: comparison with cyclic antidepressants. Archives of General Psychiatry, 36, 849–851.Google Scholar
Schou, M. & Baastrup, P. C. (1967) Lithium treatment of manic depressive disorder. Journal of the American Medical Association, 201, 696–698.Google Scholar
Stancer, H. C., Furlong, F. W. & Godse, D. D. (1970) A longitudinal investigation of lithium as a prophylactic agent for recurrent depression. Canadian Psychiatric Association Journal, 15, 29–40.Google Scholar
Stokes, P. E., Shamdian, C. A., Stoll, P. M., et al (1971) Efficacy of lithium as acute treatment of manic depressive illness. Lancet, i, 1319–1325.Google Scholar
World Health Organization (1978) Mental Disorders: Glossary and Guide to their Classification in Accordance with the Ninth Revision of the International Classification of Diseases (ICD–9). Geneva: WHO.Google Scholar
Worral, E. P., Moody, J. P., Peet, M., et al (1979) Controlled studies of acute antidepressant effects of lithium. British Journal of Psychiatry, 135, 255–262.Google Scholar
Zis, A. P. & Goodwin, F. K. (1979) Major affective disorder as a recurrent illness. A critical review. Archives of General Psychiatry, 36, 835–839.Google Scholar
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