In her letter titled "Forty Years of Lithium Treatment," Moncrieff1 attempts to explain the striking discrepancy between the results of the early placebo-controlled trials of lithium and the low efficacy reported in later observations. She believes the evidence for lithium's efficacy is invalid, as several of the early placebo-controlled studies used discontinuation design, and points to the mounting reports that lithium discontinuation may induce manic relapse. However, this phenomenon did not exist in the early systematic studies of lithium discontinuation and was not observed in the discontinuation trials to which Moncrieff is referring. In fact, in comparison with the recent observations, patients at that time responded to lithium discontinuation in a quantitatively and qualitatively different manner.
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