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Lithium Prophylaxis in Recurrent Affective Illness

Efficacy, Effectiveness and Efficiency

Published online by Cambridge University Press:  02 January 2018

R. Guscott  and
L. Taylor
R. Guscott*
Affiliation:
Mood Disorders Program, Hamilton Psychiatric Hospital, and Assistant Professor of Psychiatry, Department of Psychiatry, McMaster University Medical Centre, Hamilton, Ontario, Canada
L. Taylor
Affiliation:
Mood Disorders Program, Hamilton Psychiatric Hospital, and Assistant Professor of Psychiatry, Department of Psychiatry, McMaster University Medical Centre, Hamilton, Ontario, Canada
*
∗PO Box 585, Hamilton, Ontario, Canada L8L 2B3
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Abstract

The efficacy of lithium prophylaxis for recurrent mood disorders is well established. Despite concern that the later efficacy studies have shown poorer results, these studies (after 1980) are equally confirmatory of lithium's efficacy. However, questions have been raised with regards to the effectiveness of lithium prophylaxis under ‘ordinary’ clinical conditions. Part of the confusion stems from the failure to distinguish clearly efficacy (the potential of a treatment) from effectiveness (the results obtained under clinical conditions). Studies of effectiveness or naturalistic studies show poorer results than efficacy studies in all areas of medicine. The major reason for this discrepancy with lithium prophylaxis is poor compliance. Estimations of the efficiency (cost benefits) of lithium prophylaxis are flawed by the failure to consider such issues. It is proposed that specialised lithium or mood disorders clinics have the potential to narrow the gap between efficacy and effectiveness – efficiency.

Type
Review Articles
Information
The British Journal of Psychiatry , Volume 164 , Issue 6 , June 1994 , pp. 741 - 746
Copyright
Copyright © 1994 The Royal College of Psychiatrists 

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References

Aagaard, J. & Vestergaard, P. (1990) Predictors of outcome in prophylactic lithium treatment: a 2-year prospective study. Journal of Affective Disorders, 18, 259–266.Google Scholar
Ahlfors, U. G., Baastrup, P. C., Dencker, S. J., et al (1981) Flupenthixol decanoate in recurrent manic-depressive illness, a comparison with lithium. Acta Psychiatrica Scandinavica, 64, 226–237.CrossRefGoogle ScholarPubMed
Angst, J., Weis, P., Grof, P., et al (1970) Lithium prophylaxis in recurrent affective disorders. British Journal of Psychiatry, 116, 604–614.Google Scholar
Baastrup, P. C. & Schou, M. (1967) Lithium as a prophylactic agent. Archives of General Psychiatry, 16, 162–172.CrossRefGoogle Scholar
Baastrup, P. C., Poulsen, J. C., Schou, M., et al (1970) Prophylactic lithium: double blind discontinuation in manic-depressive and recurrent-depressive disorders. Lancet, ii, 326–330.Google Scholar
Coppen, A. (1987) Everyday management of affective disorders. Lancet, i, 866.Google Scholar
Coppen, A., Noguera, R. & Bailey, J. (1971) Prophylactic lithium in affective disorders, controlled trial. Lancet, ii, 275–279.CrossRefGoogle ScholarPubMed
Cundall, R. L., Brooks, P. W. & Murray, L. G. (1972) A controlled evaluation of lithium prophylaxis in affective disorders. Psychological Medicine, 2, 308–311.Google Scholar
Dickson, W. E. & Kendell, R. E. (1986) Does maintenance lithium therapy prevent recurrences of mania under ordinary clinical conditions? Psychological Medicine, 16, 521–530.CrossRefGoogle ScholarPubMed
Dunner, D. L., Stallone, F. & Fieve, R. R. (1976) Lithium carbonate and affective disorders: V. A double-blind study of prophylaxis of depression in bipolar illness. Archives of General Psychiatry, 33, 117–120.Google Scholar
Fieve, R. R., Kumbaraci, T. & Dunner, D. L. (1976) Lithium prophylaxis of depression in bipolar I, bipolar II, and unipolar patients. American Journal of Psychiatry, 133, 925–929.Google ScholarPubMed
Gershon, E. S., Hamovit, J. H., Guroff, J. J., et al (1987) Birth-cohort changes in manic and depressive disorders in relatives of bipolar and schizoaffective patients. Archives of General Psychiatry, 44, 314–319.CrossRefGoogle ScholarPubMed
Goodwin, F. K. & Jamison, K. R. (1990) Manic-Depressive Illness. New York: Oxford University Press.Google Scholar
Grof, P. (1987) Admission rates and lithium therapy. British Journal of Psychiatry, 150, 264–273.Google Scholar
Guscott, R. & Grof, P. (1991) The clinical meaning of refractory depression: a review for the clinician. American Journal of Psychiatry, 148, 695–704.Google ScholarPubMed
Harrow, M., Goldberg, J. F., Grossman, L. S., et al (1990) Outcome in manic disorders, a naturalistic follow-up study. Archives of General Psychiatry, 47, 665–671.Google Scholar
Hullin, R. P., McDonald, R. & Allsop, M. N. E. (1972) Prophylactic lithium in recurrent affective disorders. Lancet, i, 1044–1046.Google Scholar
Jamison, K. R., Gener, R. H. & Goodwin, F. K. (1979) Patient and physician attitudes toward lithium: relationship to compliance. Archives of General Psychiatry, 36, 866–869.CrossRefGoogle ScholarPubMed
Johnson, F. N. (1984) The History of Lithium Therapy, pp. 77–93. London: MacMillan Press.CrossRefGoogle Scholar
Joyce, P. R., Oakley-Browne, M. A., Wells, J. E., et al (1990) Birth cohort trends in major depression: increasing rates and earlier onset in New Zealand. Journal of Affective Disorders, 18, 83–89.Google Scholar
Kane, J. M., Quitkin, F. M., Rifkin, A., et al (1982) Lithium carbonate and imipramine in the prophylaxis of unipolar and bipolar II illness. Archives of General Psychiatry, 39, 1065–1069.CrossRefGoogle ScholarPubMed
Lancet (1987) Doubts about the value of maintenance lithium. Lancet, i, 424.Google Scholar
McCreadie, R. G. (1987) The economics of lithium therapy. In Depression and Mania: Modern Lithium Therapy (ed. Johnson, F. N.), pp. 257–259. Oxford: IRL Press.Google Scholar
McCreadie, R. G. & Morrison, D. P. (1985) The impact of lithium in south west Scotland. 1. Demographic and clinical findings. British Journal of Psychiatry, 146, 70–80.Google Scholar
Maj, M., Pirozzi, R. & Kemali, D. (1989) Long-term outcome of lithium prophylaxis in patients initially classified as complete responders. Psychopharmacology, 98, 535–538.Google Scholar
Markar, H. R. & Mander, A. J. (1989) Efficacy of lithium prophylaxis in clinical practice. British Journal of Psychiatry, 155, 496–500.Google Scholar
Melia, P. I. (1970) Prophylactic lithium: a double-blind trial in recurrent affective disorders. British Journal of Psychiatry, 116, 621–624.Google Scholar
O'Connell, R. A., Mayo, J. A., Flatow, L., et al (1991) Outcome of bipolar disorder on long-term treatment with lithium. British Journal of Psychiatry, 159, 123–129.Google Scholar
Page, C., Benaim, S. & Lappin, F. (1987) A long-term retrospective follow-up of patients treated with prophylactic lithium carbonate. British Journal of Psychiatry, 150, 175–179.Google Scholar
Prien, R. F., Point, P., Caffey, E. M. Jr, et al (1973a) Prophylactic efficacy of lithium carbonate in manic-depressive illness. Archives of General Psychiatry, 8, 337–341.CrossRefGoogle Scholar
Prien, R. F., Klett, C. J., Caffey, E. M., et al (1973b) Lithium carbonate and imipramine in prevention of affective episodes, a comparison in recurrent affective illness. Archives of General Psychiatry, 29, 420–425.Google Scholar
Prien, R. F., Kupfer, D. J., Mansky, P. A., et al (1984) Drug therapy in the prevention of recurrences in unipolar and bipolar affective disorders. Archives of General Psychiatry, 41, 1096–1104.Google Scholar
Quitkin, F., Rifkin, A., Kane, J., et al (1978) Prophylactic effect of lithium and imipramine in unipolar and bipolar II patients: a preliminary report. American Journal of Psychiatry, 135, 570–572.Google Scholar
Quitkin, F., Kane, J., Rifkin, A., et al (1981) Prophylactic lithium carbonate with and without imipramine for bipolar I patients: a double-blind study. Archives of General Psychiatry, 38, 902–907.CrossRefGoogle ScholarPubMed
Quitkin, F., & Wyatt, R. J. (1980) Lithium: a brake in the rising cost of mental illness. Archives of General Psychiatry, 37, 385–388.Google Scholar
Relman, A. S. (1988) Assessment and accountability, the third revolution in medical care. New England Journal of Medicine, 319, 1220–1222.CrossRefGoogle ScholarPubMed
Sackett, D. L. & Gent, M. (1979) Special articles – controversy in counting and attributing events in clinical trials. New England Journal of Medicine, 301, 1410–1412.CrossRefGoogle Scholar
Schou, M. (1988) No help from lithium? About patients who might have been but were not helped by prophylactic lithium treatment. Comprehensive Psychiatry, 29, 83–90.Google Scholar
Schou, M. (1989) Lithium prophylaxis: myths and realities. American Journal of Psychiatry, 146, 573–576.Google Scholar
Schou, M. & Weeke, A. (1988) Did manic-depressive patients who committed suicide receive prophylactic or continuation treatment at the time? British Journal of Psychiatry, 153, 324–327.Google Scholar
Shapiro, S., Skinner, E. A., Kessler, L. G., et al (1984) Utilization of health and mental health services, three epidemiologic catchment area sites. Archives of General Psychiatry, 41, 971–978.Google Scholar
Stallone, F., Shelley, E., Mendlewicz, J., et al (1973) The use of lithium in affective disorders, III: a double-blind study of prophylaxis in bipolar illness. American Journal of Psychiatry, 130, 1006–1010.Google Scholar
Tohen, M., Waternaux, C. M., Tsuang, M. T., et al (1990a) A four-year follow-up of twenty-four first-episode manic patients. Journal of Affective Disorders, 19, 79–86.CrossRefGoogle Scholar
Tohen, M., Waternaux, C. M., Tsuang, M. T., et al (1990b) Outcome in mania, a 4-year prospective follow-up of 75 patients utilizing survival analysis. Archives of General Psychiatry, 47, 1106–1111.Google Scholar
Tugwell, P., Bennett, K., Feeny, D., et al (1986) In Health Care Technology: Effectiveness, Efficiency, and Public Policy (eds Feeny, D., Guyatt, G. & Tugwell, P.), pp. 44–44. The Institute for Research on Public Policy.Google Scholar
Watkins, S. E., Callender, K., Thomas, D. R., et al (1987) The effect of carbamazepine and lithium on remission from affective illness. British Journal of Psychiatry, 150, 180–182.CrossRefGoogle ScholarPubMed
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