Does effective lithium prophylaxis result in a symptom-free state of manic-depressive illness? Some thoughts on the fine-tuning of mood stabilization

Recovered depressive or manic-depressive patients on long-term lithium medi cation may show oscillations in their state of well-being, neuropsychologic al impairment, and subclinical mood disturbances. It remains an open questi on as to whether such changes should be labeled as "subthreshold" symptoms of depression or mania, as a particular syndromal entity not directly relat ed to the "mood disorder," or as subtle side effects of lithium. Within a p sychological theory of the action of lithium, mental effects of lithium mus t be postulated and should not be simply considered as side effects. Depend ing on medical common sense and economic restrictions, the optimization and fine-tuning of lithium prophylaxis may be advisable in selected cases, inc luding counseling, family therapy, cognitive therapy, well-being therapy, o r interpersonal psychotherapy, Also, a change of medication may be consider ed in patients with subjective or objective cognitive impairment. Copyright (C) 2000 by W.B. Saunders Company.