The prophylactic effect of long‐term lithium administration in bipolar patients entering treatment in the 1970s and 1980s

Rybakowski, Janusz; Chłopocka-Woźniak, M; Suwalska, Aleksandra

doi:10.1034/j.1399-5618.2001.030203.x

Cited by 97 publications

(63 citation statements)

References 23 publications

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“…According to Grof, the responders have a characteristic clinical profile with an episodic clinical course, complete remissions, bipolar family history and low psychiatric comorbidity, approximating the classical Kraepelinian description of a manicdepressive illness. The percentage of excellent lithium responders among bipolar patients is about 30%, which has also been confirmed in the study by Rybakowski et al [9] where patients entering lithium therapy in the 1970s and 1980s were followed for a period of 10 years. However, the most exciting part of Grof's paper is an observation of the second generation of lithium-treated patients.…”

supporting

confidence: 64%

Lithium: Sixty Years Thereafter

Rybakowski

2010

Neuropsychobiology

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supporting

confidence: 64%

Lithium: Sixty Years Thereafter

Rybakowski

2010

Neuropsychobiology

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“…Their main advantage usually is the length of observation, in some instances reaching several decades 363, 364, 365. This comes at the cost of generalizability, in terms of both patient selection and non‐random treatment allocation.…”

Section: Maintenance Therapy For Bipolar Disordermentioning

confidence: 99%

Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) 2018 guidelines for the management of patients with bipolar disorder

et al. 2018

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The Canadian Network for Mood and Anxiety Treatments (CANMAT) previously published treatment guidelines for bipolar disorder in 2005, along with international commentaries and subsequent updates in 2007, 2009, and 2013. The last two updates were published in collaboration with the International Society for Bipolar Disorders (ISBD). These 2018 CANMAT and ISBD Bipolar Treatment Guidelines represent the significant advances in the field since the last full edition was published in 2005, including updates to diagnosis and management as well as new research into pharmacological and psychological treatments. These advances have been translated into clear and easy to use recommendations for first, second, and third‐ line treatments, with consideration given to levels of evidence for efficacy, clinical support based on experience, and consensus ratings of safety, tolerability, and treatment‐emergent switch risk. New to these guidelines, hierarchical rankings were created for first and second‐ line treatments recommended for acute mania, acute depression, and maintenance treatment in bipolar I disorder. Created by considering the impact of each treatment across all phases of illness, this hierarchy will further assist clinicians in making evidence‐based treatment decisions. Lithium, quetiapine, divalproex, asenapine, aripiprazole, paliperidone, risperidone, and cariprazine alone or in combination are recommended as first‐line treatments for acute mania. First‐line options for bipolar I depression include quetiapine, lurasidone plus lithium or divalproex, lithium, lamotrigine, lurasidone, or adjunctive lamotrigine. While medications that have been shown to be effective for the acute phase should generally be continued for the maintenance phase in bipolar I disorder, there are some exceptions (such as with antidepressants); and available data suggest that lithium, quetiapine, divalproex, lamotrigine, asenapine, and aripiprazole monotherapy or combination treatments should be considered first‐line for those initiating or switching treatment during the maintenance phase. In addition to addressing issues in bipolar I disorder, these guidelines also provide an overview of, and recommendations for, clinical management of bipolar II disorder, as well as advice on specific populations, such as women at various stages of the reproductive cycle, children and adolescents, and older adults. There are also discussions on the impact of specific psychiatric and medical comorbidities such as substance use, anxiety, and metabolic disorders. Finally, an overview of issues related to safety and monitoring is provided. The CANMAT and ISBD groups hope that these guidelines become a valuable tool for practitioners across the globe.

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“…Studies have shown that lithium is and remains highly effective for the treatment of classical bipolar disorder which dominated the original clinical trials [67,68] . In clinical trials with broadly diagnosed, heterogeneous bipolar spectrum disorders the efficacy of lithium has varied from low to impossible to demonstrate [69] .…”

Section: Clinical Profile Of Lithium Respondersmentioning

confidence: 99%

Sixty Years of Lithium Responders

Grof¹

2010

Neuropsychobiology

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It has been 60 years since Cade first described patients who responded to antimanic lithium treatment. Two decades later, responders to lithium stabilization emerged in larger numbers. The responses of many severely ill bipolar patients to lithium were striking and called for an explanation. Remarkable reactions to a simple ion generated hope for an uncomplicated laboratory test of response and an extensive search for suitable biological markers ensued. But despite promising reports, particularly from molecular genetics, we are still waiting for a biological elucidation of the stabilizing effects of lithium. The most useful predictor of lithium stabilization has to date been the patient’s clinical profile, based on a comprehensive clinical assessment: complete remissions and other characteristics of episodic clinical course, bipolar family history, low psychiatric comorbidity and a characteristic presenting psychopathology. In brief, the responders approximate the classical Kraepelinian description of a manic-depressive patient. But the most intriguing findings have recently emerged from prospective observations of the next generation: the children of lithium responders, their counterparts coming from parents who did not respond to lithium and controls. Overall, they indicate that parents and offspring suffer from a comparable brain dysfunction that manifests clinically in distinct stages. If the child’s predicament starts early in childhood, it presents with varied, nonaffective or subclinical manifestations that are usually nonresponsive to standard treatments prescribed according to the symptoms. The next stage then unfolds in adolescence, first with depressive and later with activated episodes. The observations have a potential to markedly enrich the prevailing understanding and management of mood disorders.

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The prophylactic effect of long‐term lithium administration in bipolar patients entering treatment in the 1970s and 1980s

Abstract: A decrease in lithium prophylactic efficacy in consecutive decades was not observed. Small differences between the bipolar patients entering lithium therapy in the 2 decades were observed in terms of the previous history of illness and during the course of lithium administration.

Cited by 97 publications

References 23 publications

Lithium: Sixty Years Thereafter

Lithium: Sixty Years Thereafter

Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) 2018 guidelines for the management of patients with bipolar disorder

Sixty Years of Lithium Responders

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