Get 20M+ Full-Text Papers For Less Than $1.50/day. Start a 14-Day Trial for You or Your Team.

Learn More →

Risk of Recurrence Following Discontinuation of Lithium Treatment in Bipolar Disorder

Risk of Recurrence Following Discontinuation of Lithium Treatment in Bipolar Disorder Abstract • Episode recurrence in bipolar disorder following discontinuation of stable maintenance treatment with lithium salts was analyzed from 14 studies involving 257 patients with bipolar I disorder. More than 50% of new episodes of illness occurred within 10 weeks of stopping an average of 30 months of treatment. By survival analysis of 124 cases in which the time to a new episode was known, the computed time to 50% failure of remission was 5.0 months after stopping therapy; the time to 25% recurrence of mania was 5.2 times earlier than for depression (2.7 vs 14 months). In 16 patients with a mean cycle length before treatment of 11.6 months, the time to a new episode when off lithium therapy was only 1.7 months. Risk of early recurrence of bipolar illness, especially of mania, evidently is increased following discontinuation of lithium use and may exceed that predicted by the course of the untreated disorder. The basis and management of risks associated with discontinuing effective long-term mood-stabilizing treatment require further study. References 1. Amdisen A. Lithium treatment of acute mania and depression over one hundred years . In: Corsini GV, ed. Current Trends in Lithium and Rubidium Therapy . Cambridge, Mass: MTP Press; 1984:11-26. 2. Baldessarini RJ. Chemotherapy in Psychiatry: Principles and Practice . Cambridge, Mass: Harvard University Press; 1985: 93-129. 3. Goodwin FK, Jamison KR. Manic Depressive Illness . New York, NY: Oxford University Press Inc; 1990. 4. Kupfer D, National Institute of Mental Health—National Institutes of Health Consensus Development Conference Panel. Mood disorders: pharmacologic prevention of recurrences . Am J Psychiatry . 1985;142:469-476. 5. Baastrup PC, Poulsen JC, Schou M, Thomsen K, Amdisen A. Prophylactic lithium: double-blind discontinuation in manicdepressive and recurrent depressive disorders . Lancet . 1970; 2:326-330.Crossref 6. Melia PI. Prophylactic lithium: a double-blind trial in recurrent affective disorders . Br J Psychiatry . 1970;116:621-624.Crossref 7. Small JG, Small IF, Moore DF. Experimental withdrawal of lithium in recovered manic-depressive patients: a report of five cases . Am J Psychiatry . 1971;127:1555-1558. 8. Cundall RL, Brooks PW, Murray LG. A controlled evaluation of lithium prophylaxis in affective disorders . Psychol Med . 1972;2:308-311.Crossref 9. Fyrö B, Petterson U. A double-blind study of the prophylactic effect of lithium in manic-depressive disease . Acta Psychiatr Scand . 1977;53( (suppl) ):17-22. 10. Christodoulou GN, Lykouras EP. Abrupt lithium discontinuation in manic-depressive patients . Acta Psychiatr Scand . 1982;65:310-314.Crossref 11. Margo A, McMahon P. Lithium withdrawal triggers psychosis . Br J Psychiatry . 1982;141:407-410.Crossref 12. Mander AJ, Loudon JB. Rapid recurrence of mania following abrupt discontinuation of lithium . Lancet . 1988;2:15-17.Crossref 13. Lapierre YD, Gagnon A, Kokkinidis L. Rapid recurrence of mania following lithium withdrawal . Biol Psychiatry . 1980;15:859-864. 14. Sashidharan SP, McGuire RJ. Recurrence of affective illness after withdrawal of long-term lithium treatment . Acta Psychiatr Scand . 1983;68:126-133.Crossref 15. Goodnick PJ. Clinical and laboratory effects of discontinuation of lithium prophylaxis . Acta Psychiatr Scand . 1985;71:608-614.Crossref 16. Molnar G, Pristach C, Feeney MG, Fava GA. A pilot study of managed lithium discontinuation . Psychopharmacol Bull . 1988;24:217-219. 17. Stallone F, Shelley E, Mendlewicz J, Fieve RR. The use of lithium in affective disorders, III: a double-blind study of prophylaxis in bipolar illness . Am J Psychiatry . 1973;130:1006-1010. 18. Prien RF, Caffey EM, Klett CJ. Prophylactic efficacy of lithium carbonate in manic-depressive illness . Arch Gen Psychiatry . 1973;28:337-341.Crossref 19. Prien RF, Klett CJ, Caffey EM. Lithium carbonate and imipramine in prevention of affective episodes . Arch Gen Psychiatry . 1973;29:420-425.Crossref 20. Prien RF, Klett CJ, Caffey EM. Lithium prophylaxis in recurrent affective illness . Am J Psychiatry . 1974;131:198-203. 21. Grof P, Cakuls P, Dostal T. Lithium drop-outs, a follow-up study of patients who discontinued prophylactic lithium in recurrent affective disorders . Int Pharmacopsychiatry . 1970;5:162-169. 22. Hullin RP, McDonald R, Allsopp MNE. Prophylactic lithium in recurrent affective disorders . Lancet . 1972;1:1044-1046.Crossref 23. Klein HE, Broucek B, Greil W. Lithium withdrawal triggers psychotic states . Br J Psychiatry . 1981;139:255-256.Crossref 24. Mendlewicz J. Lithium discontinuation in bipolar illness: a double-blind prospective controlled study . In: Corsini GV, ed. Current Trends in Lithium and Rubidium Therapy . Cambridge, Mass: MTP Press; 1984:135-141. 25. Greil W, Broucek B, Klein HE, Engel-Sittenfeld P. Discontinuation of lithium maintenance therapy: reversibility of clinical, psychological and neuroendocrinological changes . In: Emrich HM, Aldenhoff JB, Lux HD, eds. Basic Mechanisms in the Action of Lithium . Princeton, NJ: Excerpta Medica; 1982:235-248. 26. Coppen A, Noguera R, Bailey J, Burns BH, Swani MS, Hare EH, Gardner R, Maggs R. Prophylactic lithium in affective disorders: controlled trial . Lancet . 1971;2:275-279.Crossref 27. King JR, Hullin RP. Withdrawal symptoms from lithium: four case reports and a questionnaire study . Br J Psychiatry . 1983;143:30-35.Crossref 28. Mander AJ. Is there a lithium withdrawal syndrome? Br J Psychiatry . 1986;149:498-501.Crossref 29. Kaplan EL, Meier P. Non-parametric estimation from incomplete observations . J Am Stat Assoc . 1958;53:457-481.Crossref 30. Fleiss JL, Dunner DL, Stallone F, Fieve RR. The life-table: a method for analyzing longitudinal studies . Arch Gen Psychiatry . 1976;33:107-112.Crossref 31. Peto R, Pike MC, Armitage P, Breslow NE, Cox DR, Howard SV, Mantel N, McPeason K, Peto J, Smith PG. Design and analysis of randomized clinical trials involving prolonged observation of each patient, II: analysis and examples . Br J Cancer . 1977;35:1-39.Crossref 32. Mantel N, Haenszel W. Statistical aspects of the analysis of data from retrospective studies of disease . J Natl Cancer Inst . 1959;22:719-748. 33. Angst J, Felder W, Frey R. The course of unipolar and bipolar disorders . In: Schou M, Stromgren E, eds. Origin, Prevention and Treatment of Affective Disorders . Orlando, Fla: Academic Press Inc; 1979:215-226. 34. Dunner DL, Murphy D, Stallone F, Fieve RR. Episode frequency prior to lithium treatment in bipolar manic-depressive patients . Compr Psychiatry . 1979;20:511-515.Crossref 35. Zis AP, Grof P, Webster M, Goodwin FK. Prediction of relapse in recurrent affective disorder . Psychopharmacol Bull . 1980;16:47-50. 36. Angst J. Course of affective disorders . In: van Praag HM, Lader MH, Rafaelson OJ, Sachar EJ, eds. Handbook of Biological Psychiatry, IV . New York, NY: Marcel Dekker Inc; 1981:225-242. 37. Cutler NR, Post RM. Life course of illness in untreated manic-depressive patients . Compr Psychiatry . 1982;23:101-115.Crossref 38. Goodwin FK, Jamison KR. The natural course of manicdepressive illness . In: Post RM, Ballenger JC, eds. Neurobiology of Mood Disorders . Baltimore, Md: Williams & Wilkins; 1984:20-37. 39. Roy-Byrne P, Post RM, Uhde TW, Porcu T, Davis D. The longitudinal course of recurrent affective illness: life chart data from research patients at the NIMH . Acta Psychiatr Scand . 1985;71( (suppl 317) ):1-34.Crossref 40. Balon R, Yerogani VK, Pohl RB, Gershon S. Lithium discontinuation: withdrawal or relapse . Compr Psychiatry . 1988; 29:330-334.Crossref 41. Chadwick D. Drug withdrawal and epilepsy: when and how? Drugs . 1988;35:579-583.Crossref 42. Mirin SM, Schatzberg AF, Creasey DE. Hypomania and mania after withdrawal of tricyclic antidepressants . Am J Psychiatry . 1981;138:87-89. 43. Post RM. Mechanisms of action of carbamazepine and related anticonvulsants in affective illness . In: Meltzer HY, ed. Psychopharmacology: The Third Generation of Progress . New York, NY: Raven Press; 1987:567-576. 44. Pope HG Jr, McElroy SL, Keck PR Jr, Hudson JI. Valproate in the treatment of acute mania . Arch Gen Psychiatry . 1991; 48:62-68.Crossref 45. Chouinard G, Young SN, Annable L. Antimanic effects of clonazepam . Biol Psychiatry . 1983;18:451-466. 46. Modell JG, Lenox RH, Weiner S. Inpatient clinical trial of lorazepam for the management of manic agitation . J Clin Psychopharmacol . 1985;4:109-113.Crossref 47. Dose M, Emrich HM, Cording-Tommel C, von Zerssen D. Use of calcium antagonists in mania . Psychoneuroendocrinology . 1986;11:241-243.Crossref 48. Dubovsky SL, Franks RD, Allen S, Murphy J. Calcium antagonists in mania: a double-blind study of verapamil . Psychiatry Res . 1986;18:309-320.Crossref 49. Greenhouse JB, Stangl D, Kupfer DJ, Prien RF. Methodologic issues in maintenance therapy clinical trials . Arch Gen Psychiatry 1991;48:313-318.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of General Psychiatry American Medical Association

Risk of Recurrence Following Discontinuation of Lithium Treatment in Bipolar Disorder

Loading next page...
 
/lp/american-medical-association/risk-of-recurrence-following-discontinuation-of-lithium-treatment-in-fwWHsTGNk3

References (54)

Publisher
American Medical Association
Copyright
Copyright © 1991 American Medical Association. All Rights Reserved.
ISSN
0003-990X
eISSN
1598-3636
DOI
10.1001/archpsyc.1991.01810360046007
Publisher site
See Article on Publisher Site

Abstract

Abstract • Episode recurrence in bipolar disorder following discontinuation of stable maintenance treatment with lithium salts was analyzed from 14 studies involving 257 patients with bipolar I disorder. More than 50% of new episodes of illness occurred within 10 weeks of stopping an average of 30 months of treatment. By survival analysis of 124 cases in which the time to a new episode was known, the computed time to 50% failure of remission was 5.0 months after stopping therapy; the time to 25% recurrence of mania was 5.2 times earlier than for depression (2.7 vs 14 months). In 16 patients with a mean cycle length before treatment of 11.6 months, the time to a new episode when off lithium therapy was only 1.7 months. Risk of early recurrence of bipolar illness, especially of mania, evidently is increased following discontinuation of lithium use and may exceed that predicted by the course of the untreated disorder. The basis and management of risks associated with discontinuing effective long-term mood-stabilizing treatment require further study. References 1. Amdisen A. Lithium treatment of acute mania and depression over one hundred years . In: Corsini GV, ed. Current Trends in Lithium and Rubidium Therapy . Cambridge, Mass: MTP Press; 1984:11-26. 2. Baldessarini RJ. Chemotherapy in Psychiatry: Principles and Practice . Cambridge, Mass: Harvard University Press; 1985: 93-129. 3. Goodwin FK, Jamison KR. Manic Depressive Illness . New York, NY: Oxford University Press Inc; 1990. 4. Kupfer D, National Institute of Mental Health—National Institutes of Health Consensus Development Conference Panel. Mood disorders: pharmacologic prevention of recurrences . Am J Psychiatry . 1985;142:469-476. 5. Baastrup PC, Poulsen JC, Schou M, Thomsen K, Amdisen A. Prophylactic lithium: double-blind discontinuation in manicdepressive and recurrent depressive disorders . Lancet . 1970; 2:326-330.Crossref 6. Melia PI. Prophylactic lithium: a double-blind trial in recurrent affective disorders . Br J Psychiatry . 1970;116:621-624.Crossref 7. Small JG, Small IF, Moore DF. Experimental withdrawal of lithium in recovered manic-depressive patients: a report of five cases . Am J Psychiatry . 1971;127:1555-1558. 8. Cundall RL, Brooks PW, Murray LG. A controlled evaluation of lithium prophylaxis in affective disorders . Psychol Med . 1972;2:308-311.Crossref 9. Fyrö B, Petterson U. A double-blind study of the prophylactic effect of lithium in manic-depressive disease . Acta Psychiatr Scand . 1977;53( (suppl) ):17-22. 10. Christodoulou GN, Lykouras EP. Abrupt lithium discontinuation in manic-depressive patients . Acta Psychiatr Scand . 1982;65:310-314.Crossref 11. Margo A, McMahon P. Lithium withdrawal triggers psychosis . Br J Psychiatry . 1982;141:407-410.Crossref 12. Mander AJ, Loudon JB. Rapid recurrence of mania following abrupt discontinuation of lithium . Lancet . 1988;2:15-17.Crossref 13. Lapierre YD, Gagnon A, Kokkinidis L. Rapid recurrence of mania following lithium withdrawal . Biol Psychiatry . 1980;15:859-864. 14. Sashidharan SP, McGuire RJ. Recurrence of affective illness after withdrawal of long-term lithium treatment . Acta Psychiatr Scand . 1983;68:126-133.Crossref 15. Goodnick PJ. Clinical and laboratory effects of discontinuation of lithium prophylaxis . Acta Psychiatr Scand . 1985;71:608-614.Crossref 16. Molnar G, Pristach C, Feeney MG, Fava GA. A pilot study of managed lithium discontinuation . Psychopharmacol Bull . 1988;24:217-219. 17. Stallone F, Shelley E, Mendlewicz J, Fieve RR. The use of lithium in affective disorders, III: a double-blind study of prophylaxis in bipolar illness . Am J Psychiatry . 1973;130:1006-1010. 18. Prien RF, Caffey EM, Klett CJ. Prophylactic efficacy of lithium carbonate in manic-depressive illness . Arch Gen Psychiatry . 1973;28:337-341.Crossref 19. Prien RF, Klett CJ, Caffey EM. Lithium carbonate and imipramine in prevention of affective episodes . Arch Gen Psychiatry . 1973;29:420-425.Crossref 20. Prien RF, Klett CJ, Caffey EM. Lithium prophylaxis in recurrent affective illness . Am J Psychiatry . 1974;131:198-203. 21. Grof P, Cakuls P, Dostal T. Lithium drop-outs, a follow-up study of patients who discontinued prophylactic lithium in recurrent affective disorders . Int Pharmacopsychiatry . 1970;5:162-169. 22. Hullin RP, McDonald R, Allsopp MNE. Prophylactic lithium in recurrent affective disorders . Lancet . 1972;1:1044-1046.Crossref 23. Klein HE, Broucek B, Greil W. Lithium withdrawal triggers psychotic states . Br J Psychiatry . 1981;139:255-256.Crossref 24. Mendlewicz J. Lithium discontinuation in bipolar illness: a double-blind prospective controlled study . In: Corsini GV, ed. Current Trends in Lithium and Rubidium Therapy . Cambridge, Mass: MTP Press; 1984:135-141. 25. Greil W, Broucek B, Klein HE, Engel-Sittenfeld P. Discontinuation of lithium maintenance therapy: reversibility of clinical, psychological and neuroendocrinological changes . In: Emrich HM, Aldenhoff JB, Lux HD, eds. Basic Mechanisms in the Action of Lithium . Princeton, NJ: Excerpta Medica; 1982:235-248. 26. Coppen A, Noguera R, Bailey J, Burns BH, Swani MS, Hare EH, Gardner R, Maggs R. Prophylactic lithium in affective disorders: controlled trial . Lancet . 1971;2:275-279.Crossref 27. King JR, Hullin RP. Withdrawal symptoms from lithium: four case reports and a questionnaire study . Br J Psychiatry . 1983;143:30-35.Crossref 28. Mander AJ. Is there a lithium withdrawal syndrome? Br J Psychiatry . 1986;149:498-501.Crossref 29. Kaplan EL, Meier P. Non-parametric estimation from incomplete observations . J Am Stat Assoc . 1958;53:457-481.Crossref 30. Fleiss JL, Dunner DL, Stallone F, Fieve RR. The life-table: a method for analyzing longitudinal studies . Arch Gen Psychiatry . 1976;33:107-112.Crossref 31. Peto R, Pike MC, Armitage P, Breslow NE, Cox DR, Howard SV, Mantel N, McPeason K, Peto J, Smith PG. Design and analysis of randomized clinical trials involving prolonged observation of each patient, II: analysis and examples . Br J Cancer . 1977;35:1-39.Crossref 32. Mantel N, Haenszel W. Statistical aspects of the analysis of data from retrospective studies of disease . J Natl Cancer Inst . 1959;22:719-748. 33. Angst J, Felder W, Frey R. The course of unipolar and bipolar disorders . In: Schou M, Stromgren E, eds. Origin, Prevention and Treatment of Affective Disorders . Orlando, Fla: Academic Press Inc; 1979:215-226. 34. Dunner DL, Murphy D, Stallone F, Fieve RR. Episode frequency prior to lithium treatment in bipolar manic-depressive patients . Compr Psychiatry . 1979;20:511-515.Crossref 35. Zis AP, Grof P, Webster M, Goodwin FK. Prediction of relapse in recurrent affective disorder . Psychopharmacol Bull . 1980;16:47-50. 36. Angst J. Course of affective disorders . In: van Praag HM, Lader MH, Rafaelson OJ, Sachar EJ, eds. Handbook of Biological Psychiatry, IV . New York, NY: Marcel Dekker Inc; 1981:225-242. 37. Cutler NR, Post RM. Life course of illness in untreated manic-depressive patients . Compr Psychiatry . 1982;23:101-115.Crossref 38. Goodwin FK, Jamison KR. The natural course of manicdepressive illness . In: Post RM, Ballenger JC, eds. Neurobiology of Mood Disorders . Baltimore, Md: Williams & Wilkins; 1984:20-37. 39. Roy-Byrne P, Post RM, Uhde TW, Porcu T, Davis D. The longitudinal course of recurrent affective illness: life chart data from research patients at the NIMH . Acta Psychiatr Scand . 1985;71( (suppl 317) ):1-34.Crossref 40. Balon R, Yerogani VK, Pohl RB, Gershon S. Lithium discontinuation: withdrawal or relapse . Compr Psychiatry . 1988; 29:330-334.Crossref 41. Chadwick D. Drug withdrawal and epilepsy: when and how? Drugs . 1988;35:579-583.Crossref 42. Mirin SM, Schatzberg AF, Creasey DE. Hypomania and mania after withdrawal of tricyclic antidepressants . Am J Psychiatry . 1981;138:87-89. 43. Post RM. Mechanisms of action of carbamazepine and related anticonvulsants in affective illness . In: Meltzer HY, ed. Psychopharmacology: The Third Generation of Progress . New York, NY: Raven Press; 1987:567-576. 44. Pope HG Jr, McElroy SL, Keck PR Jr, Hudson JI. Valproate in the treatment of acute mania . Arch Gen Psychiatry . 1991; 48:62-68.Crossref 45. Chouinard G, Young SN, Annable L. Antimanic effects of clonazepam . Biol Psychiatry . 1983;18:451-466. 46. Modell JG, Lenox RH, Weiner S. Inpatient clinical trial of lorazepam for the management of manic agitation . J Clin Psychopharmacol . 1985;4:109-113.Crossref 47. Dose M, Emrich HM, Cording-Tommel C, von Zerssen D. Use of calcium antagonists in mania . Psychoneuroendocrinology . 1986;11:241-243.Crossref 48. Dubovsky SL, Franks RD, Allen S, Murphy J. Calcium antagonists in mania: a double-blind study of verapamil . Psychiatry Res . 1986;18:309-320.Crossref 49. Greenhouse JB, Stangl D, Kupfer DJ, Prien RF. Methodologic issues in maintenance therapy clinical trials . Arch Gen Psychiatry 1991;48:313-318.Crossref

Journal

Archives of General PsychiatryAmerican Medical Association

Published: Dec 1, 1991

There are no references for this article.