No help from lithium? About patients who might have been but were not helped by prophylactic lithium treatment

Abstract

There are patients with recurrent manic-depressive illness who might have been helped by prophylactic lithium treatment but are not. This paper analyzes reasons why lithium may not be prescribed even if indicated; why lithium may not be consumed even if prescribed; why lithium may not produce response even if consumed; and why even beneficial lithium treatment may be discontinued. Improvement of treatment efficacy or prescription of alternative prophylactic drugs may be the appropriate course of action. But often nonpharmacologic factors determine whether patients consume their medication and whether they respond to it, and concern about patient selection, patient characteristics, treatment execution, patient and therapist attitudes, treatment organization, and supplementary psychological support may more profitably serve to ensure that manic-depressive patients obtain help from prophylactic drug treatment.