Lithium prophylaxis in recurrent affective disorders

Following the first reports of a prophylactic lithium action in recurrent affective disorders (Hartigan, 1963; Schou, 1963; Baastrup, 1964; Schou and Baastrup, 1966; Baastrup and Schou, 1967), a large number of research projects on this subject have been started. Prophylactic studies yield results slowly, and reports published to date are mainly of a preliminary nature. Some have been negative; the authors found little or no evidence of prophylactic lithium action (Fieve et al., 1968; Zall et al., 1968). Other observations seem to confirm the ability of lithium to prevent manic and depressive relapses (Achté et al., 1968; Blinder, 1968; Christodoulou, 1968; Dyson and Mendels, 1968; Gershon, 1968; Gottfries, 1968; Haastrup et al., 1968; Hofmann and Boleloucky-Bolen, 1968; Hullin et al., 1968; Kerry and Owen, 1968; Lauter, 1969; Levy, 1968; Melia, 1968; Sargant, 1968; Vaadal and Robak, 1968; Annell, 1969; Forssman and Wålinder, 1969; Fries, 1969; Uddenberg, 1969). The reports are based on samples which range from a few patients to about seventy. Few deal with systematic studies.

Pharmacological and clinical problems of lithium prophylaxis

Prophylactic maintenance treatment with lithium presents a number of features not shared by conventional therapies. Patients suffering from recurrent affective disorders are offered the possibility of avoiding further psychotic episodes (Baastrup and Schou, 1967; Angstet al.,1970), but the treatment also makes demands on doctors and patients.

Methodological problems of prophylactic trials in recurrent affective disorders

During the past year the question of lithium prophylaxis has been the subject of lively debate (Blackwell and Shepherd, 1968; Hullin et al., 1968; Houghton, 1968; Baastrup and Schou, 1968a; Lader, 1968; Sargant, 1968; Saran, 1968; Baastrup and Schou, 1968b; Melia, 1968; Fieve and Platman, 1968; Cole, 1968; Kline, 1968; Kerry, 1968; Editorial, 1968; Berlyne, 1968; Silverman, 1968; Laurell and Ottosson, 1968; Lancet Editorial, 1969; Whybrow, 1969; Melia, 1969; Angst et al., 1969c). This discussion has revealed considerable uncertainty about the design and assessment of prophylactic trials, and there have been misunderstandings on important points.