title: Relapse into mania or depression following lithium discontinuation: a 7-year follow-up.
abstract: OBJECTIVE
  We aimed to assess whether outcome followed a worse course after acute lithium withdrawal.
  
  
  METHODS
  Data were acquired by review of the clinical records on 14 cases and 28 controls matched for age, gender and time on lithium for about 7 years following discontinuation.
  
  
  RESULTS
  Significant differences were found between cases and controls. Cases experienced more episodes of depression and total affective relapse. The log-rank test revealed a significantly lower survival probability in cases than controls (P < 0.0009). However, the increased risk of recurrence was largely confined to the interval immediately after lithium discontinuation.
  
  
  CONCLUSIONS
  These results confirm that acute discontinuation of lithium leads to a high immediate relapse rate. Most of the excess morbidity over 7 years appears to be attributable to the first episode following discontinuation. Outcome was not worsened by discontinuation.
authors.affiliation: University of Glasgow Department of Psychological Medicine, Academic Centre, Gartnavel Royal Hospital, Glasgow, UK. jc199d@clinmed.gla.ac.uk
authors.forename: J
authors.initials: J
authors.lastname: Cavanagh
authors.forename: R
authors.initials: R
authors.lastname: Smyth
authors.forename: G M
authors.initials: GM
authors.lastname: Goodwin
mesh_terms: D000328:Adult; D000368:Aged; D018692:Antimanic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001714:Bipolar Disorder / Q000139:chemically induced / Q000188:drug therapy* / Q000517:prevention & control; D003866:Depressive Disorder / Q000139:chemically induced / Q000517:prevention & control; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016651:Lithium Carbonate / Q000009:adverse effects / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D013375:Substance Withdrawal Syndrome / Q000175:diagnosis*
chemical_list: D018692:Antimanic Agents; D016651:Lithium Carbonate