Abstract
Patients suffering from bipolar disorder experience an episodic illness with the risk of affective recurrences throughout most of their lives. Interepisodic subsyndromal mood symptoms and cognitive impairment may also occur in a proportion of patients with bipolar disorder. There is substantial intra- and interindividual variability in symptom severity, duration and number of episodes, degree of recovery between episodes, and the polarity pattern. Given the wide range of bipolar disorder’s phenotypic expression, long-term treatment presents a major challenge for clinicians. Despite the availability of modern treatments, full, sustained recovery is difficult to achieve. By virtue of its recurrent nature and depending on the subtype of the disorder, patients have symptoms for approximately half of their lives, a finding that highlights the importance of optimizing long-term treatment and ameliorating affective symptomatology.
This is a preview of subscription content, log in via an institution.
Buying options
Tax calculation will be finalised at checkout
Purchases are for personal use only
Learn about institutional subscriptionsReferences
Angst J, Weis P, Grof P, Baastrup PC, Schou M. Lithium prophylaxis in recurrent affective disorders. Br J Psychiatry. 1970;116:604–14.
Baastrup PC, Schou M. Lithium as a prophylactic agent: its effect against recurrent depression and manic-depressive psychosis. Arch Gen Psychiatry. 1967;16:162–72.
Baastrup PC, Poulsen JC, Schou M, Thomsen K, Amdisen A. Prophylactic lithium: double-blind discontinuation in manic-depressive and recurrent-depressive disorders. Lancet. 1970;ii:326–30.
Baethge C, Smolka MN, Gruschka P, Berghöfer A, Schlattmann P, Bauer M, et al. Does prophylaxis-delay in bipolar disorder influence outcome? Results from a long-term study of 147 patients. Acta Psychiatr Scand. 2003;107(4):260–7.
Baethge C, Baldessarini RJ, Mathiske-Schmidt K, Hennen J, Berghöfer A, et al. Long-term combination therapy versus monotherapy with lithium and carbamazepine in 46 bipolar I patients. J Clin Psychiatry. 2005;66(2):174–82.
Baldessarini RJ, Tondo L. Does lithium treatment still work? Evidence of stable responses over three decades. Arch Gen Psychiatry. 2000;57(2):187–90.
Baldessarini RJ, Tondo L, Viguera AC. Discontinuing lithium maintenance treatment in bipolar disorders: risks and implications. Bipolar Disord. 1999;1:17–24.
Baldessarini RJ, Tondo L, Hennen J. Treatment-latency and previous episodes: relationships to pretreatment morbidity and response to maintenance treatment in bipolar I and II disorders. Bipolar Disord. 2003;5(3):169–79.
Baldessarini RJ, Tondo L, Faedda GL, Viguera AC, Baethge C, Bratti IM, et al. Latency, discontinuation, and re-use of lithium treatment. In: Bauer M, Grof P, Müller-Oerlinghausen B, editors. Lithium in neuropsychiatry – the comprehensive guide. Abingdon: Informa Healthcare; 2006. p. 465–81.
Bauer M. Refractoriness induced by lithium-discontinuation despite adequate serum lithium levels. Am J Psychiatry. 1994;151:1522.
Bauer MS, Mitchner L. What is a “mood stabilizer”? An evidence-based response. Am J Psychiatry. 2004;161(1):3–18.
Bauer M, Beaulieu S, Dunner DL, Lafer B, Kupka R. Rapid cycling bipolar disorder – diagnostic concepts. Bipolar Disord. 2008;10(1 Pt 2):153–62.
Bauer M, Severus E, Köhler S, Whybrow PC, Angst J, Möller HJ, Wfsbp Task Force on Treatment Guidelines for Unipolar Depressive Disorders. World Federation of Societies of Biological Psychiatry (WFSBP) guidelines for biological treatment of unipolar depressive disorders. Part 2: maintenance treatment of major depressive disorder-update 2015. World J Biol Psychiatry. 2015;16(2):76–95.
Berghöfer A, Müller-Oerlinghausen B. No loss of efficacy after discontinuation and reinstitution of long-term lithium treatment? In: Gallicchio VS, Birch NJ, editors. Lithium: biochemical and clinical advances. Cheshire: Weidner Publishing Group; 1996. p. 39–46.
Berghöfer A, Alda M, Adli M, Baethge C, Bauer M, Bschor T, et al. Long-term effectiveness of lithium in bipolar disorder: a multicenter investigation of patients with typical and atypical features. J Clin Psychiatry. 2008;69(12):1860–8.
Berghöfer A, Alda M, Adli M, Baethge C, Bauer M, Bschor T, et al. Stability of lithium treatment in bipolar disorder – long-term follow-up of 346 patients. Int J Bipolar Disord. 2013;31(1):11.
Calabrese JR, Shelton M, Rapport D, Yougstrom EA, Jackson K, Bilali S, et al. A 20-month, double-blind, maintenance trial of lithium versus divalproex in rapid cycling bipolar disorder. Am J Psychiatry. 2005;162:2152–61.
Coppen A, Peet M, Bailey J, Noguera R, Burns BH, Swani MS, Maggs R, Gardner R. Double-blind and open studies of lithium prophylaxis in affective disorders. Psychiatr Neurol Neurochir. 1973;76:501–10.
Crossley NA, Müller-Oerlinghausen B, Glenn T, Bauer M. The position of lithium in international and national guidelines for the treatment of mood disorders. In: Bauer M, Grof P, Müller-Oerlinghausen B, editors. Lithium in neuropsychiatry – the comprehensive guide. Abingdon: Informa Healthcare; 2006. p. 33–42.
Davis JM. Lithium maintenance of unipolar depression. In: Bauer M, Grof P, Müller-Oerlinghausen B, editors. Lithium in neuropsychiatry – the comprehensive guide. Abingdon: Informa Healthcare; 2006. p. 99–108.
de Vries C, van Bergen A, Regeer EJ, Benthem E, Kupka RW, Boks MP. The effectiveness of restarted lithium treatment after discontinuation: reviewing the evidence for discontinuation-induced refractoriness. Bipolar Disord. 2013;15(6):645–9.
Duffy A. Lithium treatment in children and adolescents: a selected review and integration of research findings. In: Bauer M, Grof P, Müller-Oerlinghausen B, editors. Lithium in neuropsychiatry – the comprehensive guide. Abingdon: Informa Healthcare; 2006. p. 193–205.
Duffy A, Horrocks J, Doucette S, Keown-Stoneman C, McCloskey S, Grof P. The developmental trajectory of bipolar disorder. Br J Psychiatry. 2014;204(2):122–8.
Dunner DL, Fieve RR. Clinical factors in lithium carbonate prophylaxis failure. Arch Gen Psychiatry. 1974;30:229–33.
Franchini L, Zanardi R, Smeraldi E, Gasperini M. Early onset of lithium prophylaxis as a predictor of good long-term outcome. Eur Arch Psychiatry Clin Neurosci. 1999;249:227–30.
Geddes JR, Miklowitz DJ. Treatment of bipolar disorder. Lancet. 2013;381(9878):1672–82.
Geddes JR, Burgess S, Hawton K, Jamison K, Goodwin GM. Long-term lithium therapy for bipolar disorder: systematic review and meta-analysis of randomized controlled trials. Am J Psychiatry. 2004;161(2):217–22.
Gershon S, Chengappa KN, Malhi GS. Lithium specificity in bipolar illness: a classic agent for the classic disorder. Bipolar Disord. 2009;11 Suppl 2:34–44.
Goodwin GM, Geddes J. Latest maintenance data on lithium in bipolar disorder. Eur Neuropsychopharmacol. 2003;13:51–5.
Grof P. Responders to long-term lithium treatment. In: Bauer M, Grof P, Müller-Oerlinghausen B, editors. Lithium in neuropsychiatry – the comprehensive guide. Abingdon: Informa Healthcare; 2006. p. 157–78.
Grof P, Müller-Oerlinghausen B. S3 guidelines on bipolar disorders are contemporary and important instruments for clinical practice. Against. Nervenarzt. 2013;84(7):876–8.
Grunze H, Vieta E, Goodwin GM, Bowden C, Licht RW, Möller HJ, et al. The World Federation of Societies of Biological Psychiatry (WFSBP) guidelines for the biological treatment of bipolar disorders: update 2012 on the long-term treatment of bipolar disorder. World J Biol Psychiatry. 2013;14(3):154–219.
Maj M, Pirozzi R, Kemali D. Long-term outcome of lithium prophylaxis in patients initially classified as complete responders. Psychopharmacology (Berl). 1989;98(4):535–8.
Maj M, Pirozzi R, Magliano L. Nonresponse to reinstituted lithium prophylaxis in previously responsive bipolar patients: prevalence and predictors. Am J Psychiatry. 1995;152:1810–1.
Miklowitz DJ, Gitlin MJ. Psychosocial treatment for recovery and maintenance. In: Clinician’s guide to bipolar disorder. Integrating pharmacology and psychotherapy. New York: The Guilford Press; 2014. p. 145–67.
Miura T, Noma H, Furukawa TA, Mitsuyasu H, Tanaka S, Stockton S, et al. Comparative efficacy and tolerability of pharmacological treatments in the maintenance treatment of bipolar disorder: a systematic review and network meta-analysis. Lancet Psychiatry. 2014;1(5):351–9.
Monteith S, Glenn T, Bauer M. Searching the internet for health information about bipolar disorder: some cautionary issues. Int J Bipolar Disord. 2013;1:22.
Morris R. Mandatory implementation of NICE Guidelines for the care of bipolar disorder and other conditions in England and Wales. BMC Med. 2015;13(1):246.
Müller-Oerlinghausen B, Berghöfer A, Bauer M. Bipolar disorder. Lancet. 2002;359(9302):241–7.
Nolen WA, Kupka RW, Schulte PFJ, Knoppert-van der Klein EAM, Honig A, Reichart CG. Richtlijn bipolaire stoornissen. 2nd ed. Utrecht: L De Tijdstrom uitgerverij BV; 2008.
Pfennig A, Schlattmann P, Alda M, Grof P, Glenn T, Müller-Oerlinghausen B, et al. Influence of atypical features on the quality of prophylactic effectiveness of long-term lithium treatment in bipolar disorders. Bipolar Disord. 2010;12(4):390–6.
Post RM, Leverich GS, Altshuler L, Mikalauskas K. Lithium discontinuation-induced refractoriness: preliminary observations. Am J Psychiatry. 1992;149:1727–9.
Prien RF, Caffey Jr EM, Klett CJ. Prophylactic efficacy of lithium carbonate in manic-depressive illness. Report of the Veterans Administration and National Institute of Mental Health collaborative study group. Arch Gen Psychiatry. 1973;28:337–41.
Rybakowski JK, Chlopocka-Wozniak M, Suwalska A. The prophylactic effect of long-term lithium administration in bipolar patients entering treatment in the 1970s and 1980s. Bipolar Disord. 2001;3(2):63–7.
Schaub RT, Berghöfer A, Müller-Oerlinghausen B. What do patients in a lithium outpatient clinic know about lithium therapy? J Psychiatry Neurosci. 2001;26(4):319–24.
Schou M. Litiumterapi ved mani: praktiske retningslinier. Nord Med. 1956;55:790–4.
Severus E, Taylor MJ, Sauer C, Pfennig A, Ritter P, Bauer M, et al. Lithium for prevention of mood episodes in bipolar disorders: systematic review and meta-analysis. Int J Bipolar Disord. 2014;20(2):15.
Souza FG, Goodwin GM. Lithium treatment and prophylaxis in unipolar depression: a meta-analysis. Br J Psychiatry. 1991;158:666–75.
Suppes T, Baldessarini RJ, Faedda GL, Tohen M. Risk of recurrence following discontinuation of lithium treatment in bipolar disorder. Arch Gen Psychiatry. 1991;48:1082–8.
Suppes T, Baldessarini RJ, Faedda GL, Tondo L, Tohen M. Discontinuation of maintenance treatment in bipolar disorder: risks and implications. Harv Rev Psychiatry. 1993;1(3):131–44.
Tohen M, Frank E, Bowden CL, Colom F, Ghaemi SN, Yatham LN, et al. The International Society for Bipolar Disorders (ISBD) task force report on the nomenclature of course and outcome in bipolar disorders. Bipolar Disord. 2009;11(5):453–73.
Tondo L, Baldessarini RJ, Floris G, Rudas M. Effectiveness of restarting lithium treatment after its discontinuation in bipolar I and bipolar II disorders. Am J Psychiatry. 1997;154:548–50.
Tondo L, Baldessarini RJ, Hennen J, Gianfranco F. Lithium maintenance treatment of depression and mania in bipolar I and bipolar II disorders. Am J Psychiatry. 1998;155(5):638–45.
Tondo L, Hennen J, Baldessarini RJ. Rapid-cycling bipolar disorder: effects of long-term treatments. Acta Psychiatr Scand. 2003;108:4–14.
Viguera AC, Baldessarini RJ, Tondo L. Response to lithium maintenance treatment in bipolar disorders: comparison of women and men. Bipolar Disord. 2001;3(5):245–52.
Weisler RH, Nolen WA, Neijber A, Hellqvist A, Paulsson B, Trial 144 Study Investigators. Continuation of quetiapine versus switching to placebo or lithium for maintenance treatment of bipolar I disorder (Trial 144: a randomized controlled study). J Clin Psychiatry. 2011;72(11):1452–64.
Author information
Authors and Affiliations
Rights and permissions
Copyright information
© 2016 Springer International Publishing Switzerland
About this chapter
Cite this chapter
Bauer, M., Gitlin, M. (2016). Maintenance Treatment with Lithium. In: The Essential Guide to Lithium Treatment. Springer, Cham. https://doi.org/10.1007/978-3-319-31214-9_5
Download citation
DOI: https://doi.org/10.1007/978-3-319-31214-9_5
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-319-31212-5
Online ISBN: 978-3-319-31214-9
eBook Packages: MedicineMedicine (R0)