ABSTRACT
This chapter summarizes clinical and research findings and recommendations pertaining to prophylactic treatment with lithium in patients with manic-depressive disorders: (1) delay in starting treatment; (2) discontinuing ongoing maintenance treatment; and (3) re-treatment following discontinuation. There has been substantial progress in recent years in understanding these important components of longterm prophylactic treatment with lithium salts. Several basic ideas were included in the initial report on lithium to treat mania by John Cade in 1949, which opened the modern era of psychopharmacology1. In his report of ten cases, the duration of preceding recurrent or chronic manic or manic-depressive illness ranged from 2 to 30 years in eight patients. In four cases, lithium was discontinued for a variety of clinical reasons, usually abruptly, followed by relapse
within an average of 4 weeks. In three cases, lithium treatment was re-started with evident clinical benefit. These few, very early and informal observations in possibly selected cases suggested (1) that lithium could be effective even in prolonged and severe manic-depressive illness; (2) that continued treatment might prevent recurrences, that stopping ongoing treatment, especially abruptly, was followed by early relapse; and (3) that re-starting treatment could again be clinically effective.
