Lithium carbonate: maintenance studies and consequences of withdrawal

The treatment of mood disorders with lithium carbonate has made a significant impact on the health of patients who have these disorders and on the nature of psychiatry itself. Perhaps the single, most important finding about the efficacy of lithium that has influenced American psychiatry is the fact that lithium, given over long periods of time, reduces the frequency and severity of subsequent affective episodes in manic depressive patients. This paper discusses the selection of patients for maintenance treatment, the dose of lithium, the maintenance treatment of patients who have breakthrough episodes, those with hypomanic breakthrough episodes, and rapid cycling. The use of lithium in unipolar depression and the elderly and the consequences of lithium discontinuation are also reviewed.