Lithium discontinuance

Klein E, Bental E, Lerer B, et al Carbamazepine and halopeiidol vs. placebo and haloperidol in excited psychoses. Arch Gen Psychiatry 41 165-170, 1984a Klein E, Hefez A, Lavie P Effects of clomipramine infusion on sleep in depressed patients. Neuropsychobiology 1 85-88, 1984b Klein E, Lavie P, Meiraz R, et al Increased motor activity and recurrent manic episodes risk factors that predict rapid relapse in remitted bipolar disorder patients after lithium discontinuation—a double blind study. Biol Psychiatry 31 279-284, 1992... 

Post RM, Leverich GS, Altshuler L, et al Lithium-discontinuation-induced refractoriness preliminary observations. Am J Psychiatry 149 1727-1729, 1992... 

Finally, data indicate that more rapid lithium discontinuation (e.g., less than 2 weeks) may decrease the time to recurrence ( 165). 

Early in the course of lithium therapy, exacerbations of psoriasis and acneiform eruptions as well as other skin reactions may occur. Possible mechanisms have included lithium s ability to decrease cAMP as well as to increase the number and activity of polymorphonuclear leukocytes. Those with a predisposition to skin disorders are most at risk for this complication, with women more likely than men to experience a dermatological reaction to lithium. These problems may clear spontaneously or may require lithium dose reduction, appropriate dermatological intervention, or lithium discontinuation ( 77). 

Grindlinger GA, Boylan MJ. Amelioration by indomethacin of lithium discontinuation. Crit Care Med 1987 15 538-539. 

Kocsis JH, Shaw E, Stokes PE, et al. Neuropsychologic effects of lithium discontinuation. J Clin Psychopharmacol 1993 13 268-275. 

Although it is now widely acknowledged that lithium discontinuation can induce relapse, the full implications of this phenomenon have been avoided. In 2001 the principle American textbook of psychiatry ignored it altogether. It even cited one of the papers that demonstrated the occurrence of withdrawal-related relapse (Suppes et al. 1991) as evidence in support of its recommendation of lifelong drug treatment for manic depression (Marangell et al. 2001, p. 1115). 

The problems of lithium discontinuation are recognised in recent meta-analyses of the prophylactic efficacy of lithium and studies that employ a classical discontinuation design are excluded. Table 12.1 lists studies included in the latest meta-analysis (Geddes et al. 2004). However as mentioned above, even these studies all involve lithium discontinuation to some degree. Therefore, the higher rates of mania in... 

Cavanagh, J., Smyth, R., Goodwin, G. M. 2004, Relapse into mania or depression following lithium discontinuation a 7-year follow-up, Acta Psychiatr.Scand., vol. 109, no. 2, pp. 91-95. 

Verdoux, H. Bourgeois, M. 1993, Short-term sequelae of lithium discontinuation, Encephale, vol. 19, no. 6, pp. 645-650. 

Yazici, O., Kora, K., Polat, A., Saylan, M. 2004, Controlled lithium discontinuation in bipolar patients with good response to long-term lithium prophylaxis, J.Affect.Disord., vol. 80, no. 2-3, pp. 269-271. 

In 28 patients who had responded to lithium treatment of mania or schizoaffective mania and who had recurrences after withdrawal, there were equally good responses to retreatment with lithium (461). These findings add to the evidence that lithium discontinuation-induced refractoriness is the exception rather than the rule. However, the issue of whether post-withdrawal refractoriness to reintroduction of lithium is a real phenomenon and, if so, how often it occurs continues to be debated (462). Three patients failed to respond to the reintroduction of lithium, despite having had sustained beneficial responses before withdrawal (463). 

Faedda GL, Tondo L, Baldessarini RJ. Lithium discontinuation uncovering latent bipolar disorder Am J Psychiatry 2001 158(8) 1337-9. 

Coryell W, Solomon D, Leon AC, Akiskal HS, Keller MB, Scheftner WA, Mueller T. Lithium discontinuation and subsequent effectiveness. Am J Psychiatry 1998 155(7) 895-8. 

Coryell WH, Leon AC, Scheftner W. Lithium discontinuation. Dr Coryell and colleagues reply. Am J Psychiatry 1999 156 1130. 

Abrupt lithium discontinuation leads to rebound mania (and thus more manic... 

A case of assumed lithium-induced nephrogenic DI persisting at least 4 years after discontinuation of lithium, and unmasked with fluid restriction after bariatric gastric banding surgery is described in a 40-year-old woman with bipolar disorder [103 ]. Persisting DI after lithium discontinuation has been previously reported, but usually for briefer periods of time. 

A study in which elderly patients on lithium and an estimated GFR of <60 mL/min/1.73 m were either continued on lithium (n=17), or had the lithium discontinued, were followed for 60 months. This was not a random assignment study, and the data were collected retrospectively [Tl n ca study] gfjjj qJ 60 months there was no difference... 

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