Reactive affective cycles and lithium: a caveat

The author has been referred increasing numbers of patients who were inappropriately treated with Lithium for cyclic "depressions" which were in fact reactive-depressive episodes resulting from cyclic patterns of interpersonal behavior. This paper gives two case reports to demonstrate the phenomenon of reactive-affective cycles, their clinical presentations and the problems arising from treatment with medications. The structure of cycles of interpersonal behavior and their presentation in therapy is described and treatment strategies are suggested.