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Unanswered Questions, Unknown Future for One of Our Oldest Medications

Michael J. Gitlin, MD; Lori L. Altshuler, MD
Arch Gen Psychiatry. 1997;54(1):21-23. doi:10.1001/archpsyc.1997.01830130025005.
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A S one of the oldest pillars of modern psychopharmacology, lithium remains a treatment toward which all psychiatrists should feel a deep indebtedness. The decreased morbidity associated with its demonstrated efficacy in both the acute and maintenance phases of bipolar disorder has provided greatly needed relief and hope for patients and their families. More than any other individual, Dr Mogens Schou has been responsible for demonstrating lithium's efficacy and promoting its use. Now, 40 years after lithium's introduction into psychiatry, he reviews some of the current controversies about this remarkable drug.2

LITHIUM AS A Maintenance TREATMENT  One of Schou's concerns is the underappreciation of lithium's capacity as a maintenance treatment for bipolar disorder. He alludes to the recent naturalistic studies that suggest that lithium seems less effective in these samples than in the many controlled studies. In a previous publication,3 he concluded that the results of these naturalistic


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