Long Term Lithium Prophylaxis Is beneficial for bipolar but not for unipolar depression ...

In an open study, 104 outpatients suffering from a bipolar depression (n = 56), unipolar depression (20) or schizo-affective disorder (schizo-manic, 9, schizo-depressive, 5 and bipolar, 14) were treated with lithium. A mean monthly serum level of ~ 0.05 mmoi/L and not less than 0.4 mmolfl during 3 consecutive months was achieved in 94% of the patients. Six patients died during or soon after the prophylaxis, one of whom committed suicide.

The bipolar and schizo-affective groups both showed significant improvements during prophylaxis in the occurrence of episodes and the number of hospital admissions, compared with both the same length of time preceding the prophylaxis and immediately after prophylaxis. However, in the unipolar group, no improvement was seen during prophylaxis (although these patients experienced less hospital admissions initially). A greater number of hospital admissions, a greater number of episodes experienced before lithium administration and a longer duration of prophylaxis were all associated with greater effectiveness of prophylaxis. Unipolar depression was associated with a decreased effectiveness.

'Our results show a beneficial effect of long-term lithium prophylaxis in bipolar and schizo-affective disorders.' However, there is an urgent requirement for the standardisation of classification criteria and selection criteria to enable comparison and interpretation of such studies. Bouman TK. Niemantsverdnet·van Kampen JG. Ormel J. Slooff CJ. Journal of Affect1ve D1sorders 1 275·280, Nov·Dec 1986

... and efficacy may be predicted in affective disorders In an open study, 98 outpatients with a primary affective disorder classified as:

e bipolar I - with a history of hospitalisation for mania, n = 54 • bipolar II - with a history of hospitalisation for depression and outpatient treatment for mania, n = 27 e bipolar, other- outpatient treatment for mania and depression, n = 10 e unipolar or unipolar, other- without mania or hypomania, n = 7

received a daily prophylactic dose of lithium 600-1500mg (according to bodyweight, age, medical status and acquiescence) to achieve a mean final blood lithium concentration of 0.71 meq/L, for a mean durat1on of 44.6 months. The numbers of affective episodes/year before treatment were < 1 (n = 22). 1 (36), 2 or 3 (26) and ~ 4 (7).

Manic symptoms occurred most frequently in the bipolar I patients. followed by bipolar, other and bipolar II patients. Depressive symptoms, mood shifts. side effects and relapse rate per visit did not vary significantly between groups. The mean number of depressive symptoms was significantly higher in patients with ~ 4 relapses/year before treatment than in those with 2 or 3, I or < 1 relapse/year. The highest mean number of mood shifts per visit and highest rate of manic relapses among patients was also seen in this group.

A significant correlation was seen between increased duration of lithium therapy and lower number of manic symptoms, lower number of mood shifts, lower rates of manic relapse and lower rates of depressive relapse. Correspondingly, the more symptoms and less mood stability a patient reported, the higher the rate of a manic {p < 0.001) or depressive (p < 0.001) relapse. A higher frequency of manic symptoms correlated with a higher manic relapse rate (p < 0.001 ), and a higher frequency of depressive symptoms with a higher depressive relapse rate (p < 0.001 ). The number of adverse effects per visit significantly correlated with the number of depressive symptoms per visit.

In conclusion, long term prophylactic response appeared to be primarily indicated by pre-lithium frequency of episodes, duration of treatment with lithium and inter-episode symptoms including mood shifts. However, 'it must be emphasized, as with all retrospective evaluations, that a controlled, randomized study should be done to replicate our results'. Goodnick PJ, FMM! RR. Schlegel A. Baxter A. American Journal of Psychiatry 144 367-369, Mar 1987

0156-2703/87/0404-0015/0$01.00/0 © ADIS Press INPHARfiAS 4 April 1987 15