Depression as a lethal disease: prevention strategies

In 1971, my colleagues and I published the first prospective double-blind trial of the prophylactic effect of lithium in patients suffering from both unipolar and bipolar illness. In this trial we found that patients who received lithium experienced significantly less morbidity and required significantly less additional antidepressant and antimanic medication, as well as inpatient treatment and electroconvulsive therapy, compared with the patients who received placebo lithium. Subsequent to this trial we established a lithium clinic in which patients, both unipolar and bipolar, were given longterm lithium treatment. The patients attended regularly, usually four to eight times a year, and their clinical state and plasma lithium were regularly monitored and recorded. Patients were given lithium in a sustained-release form, once a day at night. In a careful random, double-blind trial, it was found that the optimum lithium dosage was that which gave a plasma level of 0.5-0.79 mmol/L 12 hours after the nightly dose. In 1982 all patients were switched to this lower dosage, and the recorded morbidity of the group showed a small but significant decline, thus confirming in practice the optimum dosage found in the double-blind trial. I report here the results of the follow-up of a group of 103 patients (67 unipolar, 30 bipolar, and 6 schizoaffective) from January 1977. The patients' mortality and, in particular, suicide rate has been carefully recorded. Compliance with the regimen had been high. At the end of December 1992, there had been 2 suicides in the group--one of the patients had discontinued taking lithium some months before the suicide.(ABSTRACT TRUNCATED AT 250 WORDS)