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Recurrence of Mania after Lithium Withdrawal

The usual indications for starting lithium treatment are well known: conventional wisdom usually requires two illnesses within two years, or three illnesses in five years in otherwise uncomplicated cases. The usual factors inhibiting the use of lithium are its acknowledged danger in overdose, its side effects and associated inconveniences to the patient, and uncertainty about the subsequent course of the illness. The established frequency of episodes should dictate how long lithium must be taken in order to produce benefit (Goodwin & Jamison, 1990). Currently, the implications of stopping treatment prematurely and whether this may do harm are not considered. I argue that the risk of a manic recurrence soon after lithium withdrawal in bipolar patients has major implications for how we should employ lithium. While the phenomenon has been described and discussed by others, the clinical implications for how to use lithium, or how not to use it, have not been explored fully so far.