Relapse following discontinuation of lithium maintenance therapy in adolescents with bipolar I illness: a naturalistic study

Article Abstract:

It is estimated that 15 to 30 percent of individuals with bipolar illness have an episode of depression or mania before the age of 20 years. For this study, bipolar I illness was defined using the criteria in the Diagnostic and Statistical Manual of Mental Disorders, third edition (DSM-III); these criteria include the presence of manic disorder without psychosis. Thirty-seven adolescents with bipolar I illness were evaluated after their symptoms had been stabilized with lithium, the drug of choice in treating this disease. After the patients were released from the hospital, they were monitored every four to six weeks for 18 months. The frequency of depressive and manic relapses was observed in the subjects during this follow-up period. Of the total group, 24 patients (65 percent) continued lithium maintenance therapy throughout the follow-up period without interruption, and 13 patients (35 percent) discontinued their therapy against medical advise. There were no significant differences between these two groups with regard to sex, age, or medical history. More than half (57 percent) of the total group relapsed during follow-up, but the relapse rate among those who discontinued lithium was three times that of compliant patients. Twelve out of the 13 noncompliant patients relapsed, while only nine out of the 24 patients who continued to take their medication relapsed. Some of the clinical and theoretical implications of these findings are discussed. The relapse rate in these adolescents was similar to that which has been observed in comparable adult groups. In general, patients who experience early relapse run a higher risk of subsequent relapse. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects

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Alternatives to lithium for preventive treatment of bipolar disorder

Article Abstract:

The development of lithium therapy as a preventive or prophylactic treatment for bipolar disorders has been one of the most significant advances in the mental health field in recent years. Bipolar disorder, chronic depression combined with at least one manic episode, affects 0.8 percent of the adult population of the US according to the National Institute of Mental Health (NIMH). Difficulties with lithium treatment include undesirable side effects, often resulting in noncompliance by some patients with regard to treatment. Thus far, no comparable effective treatment has been devised, but alternative methods of therapy are being explored and show some promise. The use of long-term drug therapies which prevent or ameliorate manic or depressive episodes was examined. Most of the difficulties lie in the development and effective evaluation of trial studies which provide insight into the long-range effects of drugs used in the preventive maintenance bipolar episodes. Carbamazepine, an anticonvulsant which also exhibits antidepressant properties, is being examined as an alternative to lithium. The effectiveness of this drug requires more systematic examination; in particular, the authors recommended research into the effects of carbamazepine alone and carbamazepine used in conjunction with lithium. The development of additional experimental models is suggested to investigate the benefits of carbamazepine treatment as a backup to lithium or a primary treatment in itself. More clarification is also needed between the role of antipsychotic and antidepressant drugs in the long-term care of the bipolar patient.

Carbamazepine

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Episode sequence in bipolar disorder and response to lithium treatment

Article Abstract:

Factors that have been associated with a good response to lithium treatment in patients with bipolar disorder include good recovery between episodes, a family history of bipolar disorder, and a high recurrence rate.l Poor treatment response has been associated with poor compliance with medication, rapid cycling, (four or more episodes of mania and depression a year), alcohol abuse, and episodes of mixed mania and depression. Four bipolar disorder subgroups have been proposed based on episode-interval sequence: mania or hypomania followed by depression and then normal mood; depression followed by mania; continuous cycling; and no regular sequence. Data from five studies using these criteria for sequence typing were obtained to determine the prevalence of each sequence and the associated treatment responses. Of 576 bipolar disorder cases reviewed, the order of prevalence was as follows: mania or hypomania-depression, depression-mania or hypomania, irregular, and continuous cycling. In terms of treatment response, the rank from best to worst was: mania or hypomania-depression, irregular, continuous cycling in long cycles, depression-mania or hypomania, and continuous cycling in rapid cycles. It is concluded that bipolar episode sequences can predict patient response to lithium. (Consumer Summary produced by Reliance Medical Information, Inc.)

Lithium carbonate

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