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Evidence of Stable Responses Over Three Decades

Ross J. Baldessarini, MD; Leonardo Tondo, MD

Arch Gen Psychiatry. 2000;57:187-190.

To evaluate whether lithium treatment has been overvalued and may be no longer as effective as formerly, we reviewed published reports on long-term lithium treatment (1970-1996) as well as analyzing its clinical effects on 360 patients with DSM-IV bipolar disorder who entered into lithium maintenance monotherapy after 1970. Neither reported recurrence rates nor average proportions of time ill nor patient improvement of 50% or more during lithium maintenance therapy in a stable clinic setting has changed significantly since the 1970s. Unfavorable results in some settings may reflect accumulation over time of patients with complex, less treatment-responsive illnesses. Lithium is unmatched in research support for long-term clinical effectiveness against morbidity and mortality associated with depression or mania in bipolar I and II disorders. Data evaluated herein did not support suggestions that benefits of lithium have been exaggerated in the past or have been lost recently.

From the International Consortium for Bipolar Disorder Research, the Consolidated Department of Psychiatry, Harvard Medical School, Boston, Mass, and the Bipolar and Psychotic Disorders Program, McLean Division of Massachusetts General Hospital, Belmont, Mass (Drs Baldessarini and Tondo); and the Department of Psychology, University of Cagliari and Centro Lucio Bini, Cagliari, Sardinia (Dr Tondo).

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