Failure to prevent the recurrence of manic or depressive episodes was observed in 27 of 55 bipolar (manic-depressive) patients who received lithium carbonate for from 6 to 66 months. Several clinical features of these patients were examined to determine if any predicted lithium carbonate prophylaxis failure.
Patients whose frequency of affective episodes was at least four per year (rapid cyclers) were disproportionally represented in the prophylaxis-failure group. For the nonrapid cyclers, prophylaxis failure occurred mainly in the first year of lithium carbonate treatment and tended to be characterized by more than one affective episode. Most of the rapid cyclers continued to be ill even after two years or more of lithium carbonate treatment, although some beneficial effects of lithium carbonate could be demonstrated in the rapid cycler group.