A recent issue of Current Opinion in Psychiatry Presented a section on mood disorders; two reviews by American authors dealt with longterm treatment. One1 described maintenance treatment with antidepressants and electroconvulsive therapy (ECT) but did not mention prophylactic lithium treatment. The other2 concluded that, in unipolar depressive disorder, "the routine use of lithium salts instead of, or in combination with, antidepressants does not appear well-justified as a firstline maintenance treatment." In the author's opinion, two studies had shown lithium treatment to be ineffective in patients with unipolar disorder: British psychiatrists3 found no advantage of treatment with amitriptyline plus lithium over treatment with amitriptyline alone, and an American study4 found treatment with lithium no better than placebo in patients whose index episode had been severe (although as effective as imipramine in those with an index episode of moderate intensity).
The former finding reveals, however, nothing about the