Relapse into mania or depression following lithium discontinuation: a 7-year follow-up


Jonathan Cavanagh, University of Glasgow Department of Psychological Medicine, Academic Centre, Gartnavel Royal Hospital, Great Western Road, Glasgow G12 0XH, UK


Objective:  We aimed to assess whether outcome followed a worse course after acute lithium withdrawal.

Method:  Data were acquired by review of the clinical records on 14 cases and 28 controls matched for age, gender and time on lithium for about 7 years following discontinuation.

Results:  Significant differences were found between cases and controls. Cases experienced more episodes of depression and total affective relapse. The log-rank test revealed a significantly lower survival probability in cases than controls (P < 0.0009). However, the increased risk of recurrence was largely confined to the interval immediately after lithium discontinuation.

Conclusion:  These results confirm that acute discontinuation of lithium leads to a high immediate relapse rate. Most of the excess morbidity over 7 years appears to be attributable to the first episode following discontinuation. Outcome was not worsened by discontinuation.