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Discontinuing lithium maintenance treatment in bipolar disorders: risks and implications
R J Baldessarini1, L Tondo, A C Viguera
1The International Consortium for Bipolar Disorders Research, Consolidated Department of Psychiatry and Neuroscience Program, Harvard Medical School, Boston, MA, USA. rjb@mclean.org
Bipolar Disorders
|March 21, 2001
Summary
Discontinuing lithium maintenance treatment increases affective morbidity and suicidal risk. Gradual discontinuation reduces early recurrences and suicidal risk, especially in bipolar II disorder patients.
Area of Science:
- Psychiatry
- Pharmacology
- Clinical Medicine
Background:
- Lithium is a cornerstone maintenance treatment for bipolar disorder.
- Discontinuation of maintenance treatment can precipitate relapse.
Purpose of the Study:
- To review clinical effects of discontinuing lithium maintenance treatment.
- To assess the impact on affective morbidity and suicidal risk.
Main Methods:
- Review of studies published since 1970.
- Inclusion of recent research findings.
Main Results:
- Discontinuation of lithium led to significant increases in early affective morbidity and suicidal risk.
- Gradual discontinuation markedly reduced early recurrences of mania or depression, with greater effect in bipolar II disorder.
- Similar adverse effects were observed in pregnant and nonpregnant women post-discontinuation.
Conclusions:
- Recurrences increased sharply after lithium discontinuation but were limited by slow tapering.
- Discontinuation effects may stem from long-term pharmacodynamic adaptations, similar to other medications.
- Post-discontinuation relapse risk necessitates careful consideration in clinical management and research protocols.