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In her letter titled "Forty Years of Lithium Treatment," Moncrieff¹ attempts to explain the striking discrepancy between the results of the early placebo-controlled trials of lithium and the low efficacy reported in later observations. She believes the evidence for lithium's efficacy is invalid, as several of the early placebo-controlled studies used discontinuation design, and points to the mounting reports that lithium discontinuation may induce manic relapse. However, this phenomenon did not exist in the early systematic studies of lithium discontinuation and was not observed in the discontinuation trials to which Moncrieff is referring. In fact, in comparison with the recent observations, patients at that time responded to lithium discontinuation in a quantitatively and qualitatively different manner.

The early studies focused on typical, episodic affective disorders diagnosed in the International Classification of Diseases (Kraepelinean) tradition. The recurrences after discontinuation developed after a period expected from their untreated, prelithium course,^2-4 and were . . . [Full Text of this Article]

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Lithium: An Orphan Drug
Rosenthal
Arch Gen Psychiatry 2001;58:973-973.
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