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Lithium Prophylaxis in Recurrent Affective Illness

Efficacy, Effectiveness and Efficiency

Published online by Cambridge University Press:  02 January 2018

R. Guscott  and
L. Taylor
R. Guscott*
Affiliation:
Mood Disorders Program, Hamilton Psychiatric Hospital, and Assistant Professor of Psychiatry, Department of Psychiatry, McMaster University Medical Centre, Hamilton, Ontario, Canada
L. Taylor
Affiliation:
Mood Disorders Program, Hamilton Psychiatric Hospital, and Assistant Professor of Psychiatry, Department of Psychiatry, McMaster University Medical Centre, Hamilton, Ontario, Canada
*
∗PO Box 585, Hamilton, Ontario, Canada L8L 2B3
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Abstract

The efficacy of lithium prophylaxis for recurrent mood disorders is well established. Despite concern that the later efficacy studies have shown poorer results, these studies (after 1980) are equally confirmatory of lithium's efficacy. However, questions have been raised with regards to the effectiveness of lithium prophylaxis under ‘ordinary’ clinical conditions. Part of the confusion stems from the failure to distinguish clearly efficacy (the potential of a treatment) from effectiveness (the results obtained under clinical conditions). Studies of effectiveness or naturalistic studies show poorer results than efficacy studies in all areas of medicine. The major reason for this discrepancy with lithium prophylaxis is poor compliance. Estimations of the efficiency (cost benefits) of lithium prophylaxis are flawed by the failure to consider such issues. It is proposed that specialised lithium or mood disorders clinics have the potential to narrow the gap between efficacy and effectiveness – efficiency.

Type
Review Articles
Information
The British Journal of Psychiatry , Volume 164 , Issue 6 , June 1994 , pp. 741 - 746
Copyright
Copyright © 1994 The Royal College of Psychiatrists 

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