Manic depressive disorder and lithium over the decades: the very educational case of Mrs. L.
BACKGROUND
Manic depressive disorder is a recurrent illness with a variable clinical course. Before the advent of modern pharmacotherapy, ECT was a common treatment; more recently, lithium has become the long-term treatment of choice, but it is a treatment that is not without complications.


METHODS
The psychiatric and medical history of an 80-year-old patient was reviewed and analyzed based on clinical interview and medical records. The findings were integrated with literature review to illustrate a number of important clinical points about manic depressive disorder and its treatment.


RESULTS
(1) ECT is an effective treatment for mania, (2) a sustained remission may occur spontaneously, (3) a mania-depression-euthymia episode sequence predicts favorable response to lithium, (4) lithium discontinuation is not without risk, (5) lithium continuation is not without risk (thyroid, kidneys, eyes).


CONCLUSIONS
The case of Mrs. L illustrates the longitudinal course of manic depressive disorder and how it can be influenced by treatment and withdrawal of treatment. It also illustrates the potential of lithium for causing adverse effects on several organ systems.
Jefferson
J W
JW
Dean Foundation for Health, Research and Education, Madison, WI 53717-1914.
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D000368:Aged; D000369:Aged, 80 and over; D001714:Bipolar Disorder / Q000139:chemically induced / Q000188:drug therapy / Q000523:psychology / Q000628:therapy*; D004334:Drug Administration Schedule; D004565:Electroconvulsive Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007037:Hypothyroidism / Q000139:chemically induced; D007676:Kidney Failure, Chronic / Q000139:chemically induced; D016651:Lithium Carbonate / Q000009:adverse effects / Q000627:therapeutic use*; D009395:Nephritis, Interstitial / Q000139:chemically induced; D009759:Nystagmus, Pathologic / Q000139:chemically induced; D011141:Polyuria / Q000139:chemically induced; D013375:Substance Withdrawal Syndrome / Q000209:etiology; D016896:Treatment Outcome; D014635:Valproic Acid / Q000627:therapeutic use
D016651:Lithium Carbonate; D014635:Valproic Acid