title: Long-term clinical effectiveness of lithium maintenance treatment in types I and II bipolar disorders.
abstract: BACKGROUND
  The effectiveness of lithium is being questioned increasingly and requires clarification.
  
  
  OBJECTIVE
  To assess the effectiveness of lithium treatment in depression and mania, syndromal types I and II, with predominantly mixed or psychotic episodes or rapid cycling, during treatment resumed following discontinuation, and across three decades.
  
  
  METHODS
  The longitudinal course of 360 patients with bipolar disorder compliant with lithium treatment for at least 1 year and without comorbidity for substance use disorder was reviewed.
  
  
  RESULTS
  Risk of single-episode recurrences, a common index of treatment failure, was similar to that in other reports. Both episode frequency and 'time ill' improved more in type II than type I cases. Reduced morbidity during treatment was similar in patients with mixed or psychotic episodes, or rapid cycling, and in less complex cases. Retreatment yielded minor decrements in response, and there was no tendency for lesser responses in more recent years.
  
  
  CONCLUSIONS
  Based on overall affective morbidity, long-term lithium treatment in compliant patients without comorbid substance use disorder, though imperfect, remains effective, even in subgroups of supposedly poor prognosis.
authors.affiliation: Department of Psychology, University of Cagliari, Sardinia, Italy and McLean Hospital, Department of Psychiatry, Harvard Medical School, Boston, USA. ltondo@aol.com
authors.forename: L
authors.initials: L
authors.lastname: Tondo
authors.forename: R J
authors.initials: RJ
authors.lastname: Baldessarini
authors.forename: G
authors.initials: G
authors.lastname: Floris
mesh_terms: D000328:Adult; D018692:Antimanic Agents / Q000627:therapeutic use*; D001714:Bipolar Disorder / Q000188:drug therapy*; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D018020:Lithium Compounds / Q000627:therapeutic use*; D008137:Longitudinal Studies; D008297:Male; D012008:Recurrence; D016896:Treatment Outcome
chemical_list: D018692:Antimanic Agents; D018020:Lithium Compounds