BMJ 2002;324:989-990 ( 27 April )

Editorials

Lithium in bipolar mood disorder

Evidence suggests that lithium should still be first choice for prophylactic treatment

The first 150 words of the full text of this article appear below.

Bipolar affective disorder, also called manic depression, is a common condition associated with multiple relapses often leading to unemployment, marital problems, alcohol abuse, and suicide. The lifetime prevalence is more than 1%, and 10-20% of patients commit suicide. Cade was the first to report the anti-manic effect of lithium, and by the late 1960s its role in the prophylaxis of bipolar disorder was established.1 In the next decade it became widely used on both sides of the Atlantic as the first line of treatment for the condition. Recent prescribing patterns indicate that the use of lithium in the United States is declining relative to its use in European and other countries such as Australia. The evidence, however, suggests that lithium should be the first choice in the prophylactic treatment of most patients with bipolar disorder.

Some American clinicians no longer prescribe lithium because it is too toxic and alternatives are . . . [Full text of this article]
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Relevant Article

New trial should clarify lithium use in bipolar disorder
John Geddes, Guy Goodwin, Jennifer Rendell, Jane Hainsworth, Emma Van der Gucht, and Heather Young
BMJ 2002 325: 441. [Extract] [Full Text]

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Rapid Responses:

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Uncertainty in the maintenance treatment of bipolar disorder: the need for BALANCE
John R Geddes, et al.
bmj.com, 2 May 2002 [Full text]
Evidence for lithium is inadequate
Joanna Moncrieff
bmj.com, 3 May 2002 [Full text]
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