How effective is lithium in the prevention of relapse in bipolar disorder? A prospective naturalistic follow-up study.
OBJECTIVE
The effectiveness of lithium in preventing recurrences of bipolar disorder was examined prospectively for 2 years in two representative samples of bipolar I patients being treated in a comprehensive program following recommended guidelines.


METHODS
One hundred and twenty patients were recruited from consecutive admissions to two catchment area psychiatric services (one in the United Kingdom, the other in New Zealand). They were seen at 3-monthly intervals by a member of the research team. Treatment was adjusted according to clinical needs.


RESULTS
Overall, two-thirds of the patients had a recurrence. Of the 57 on lithium as sole treatment, 39 (68%) had a further episode; 17 after stopping lithium. The 42 on other mood stabilisers and/or an antipsychotic, with or without lithium, did no better. By contrast, only eight (38%) of the 21 who were taking no prophylactic medication had a recurrence.


CONCLUSIONS
Lithium is much less effective in clinical practice than would be expected from clinical trial results. A major reason for this is poor compliance. Alternative treatment strategies are needed to improve the outcome for bipolar disorder patients.
Silverstone
T
T
Department of Psychological Medicine, Dunedin School of Medicine, University of Otago, New Zealand.
McPherson
H
H
Hunt
N
N
Romans
S
S
D000293:Adolescent; D000328:Adult; D000368:Aged; D018692:Antimanic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001714:Bipolar Disorder / Q000175:diagnosis / Q000188:drug therapy* / Q000523:psychology; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016651:Lithium Carbonate / Q000009:adverse effects / Q000627:therapeutic use*; D008131:London; D008297:Male; D008875:Middle Aged; D009520:New Zealand; D010349:Patient Compliance / Q000523:psychology; D011446:Prospective Studies; D012008:Recurrence; D016896:Treatment Outcome
D018692:Antimanic Agents; D016651:Lithium Carbonate