To the Editor.—
Lipinski and Pope1 and Forrest2 have described four patients with acute mania who appeared to respond favorably to a combination of lithium carbonate and carbamazepine. We report a favorable but brief response to that combination in a patient who had not responded adequately to either drug alone.
Report of a Case.—
A 35-year-old, divorced man with a nine-year history of major affective disorder, manic type, had a ten-year psychiatric history that included multiple psychiatric hospitalizations. He had undergone a variety of therapeutic regimens, including electroconvulsive therapy. With lithium carbonate therapy alone, the patient would exhibit what had come to be a familiar pattern of psychotic decompensation, including insomnia, agitation, flight of ideas, and excessive religiosity. For several years before admission, he had been receiving maintenance therapy with lithium carbonate (1,500 mg/day) and haloperidol (10 mg/day). Serum lithium levels, measured repeatedly over the years, had consistently