HOW EFFECTIVE IS LITHIUM IN THE PREVENTION OF RELAPSE IN BIPOLAR DISORDER - A PROSPECTIVE NATURALISTIC FOLLOW-UP-STUDY

Objective: The effectiveness of lithium in preventing recurrences of b ipolar disorder was examined prospectively for 2 years in two represen tative samples of bipolar I patients being treated in a comprehensive program following recommended guidelines. Method: One hundred and twen ty patients were recruited from consecutive admissions to two catchmen t area psychiatric services (one in the United Kingdom, the other in N ew Zealand). They were seen at 3-monthly intervals by a member of the research team. Treatment was adjusted according to clinical needs. Res ults: Overall, two-thirds of the patients had a recurrence. Of the 57 on lithium as sole treatment, 39 (68%) had a further episode; 17 after stopping lithium. The 42 on other mood stabilisers and/or an antipsyc hotic, with or without lithium, did no better. By contrast, only eight (38%) of the 21 who were taking no prophylactic medication had a recu rrence. Conclusions: Lithium is much less effective in clinical practi ce than would be expected from clinical trial results. A major reason for this is poor compliance. Alternative treatment strategies are need ed to improve the outcome for bipolar disorder patients.