Long-term therapy with lithium in a private practice clinic: a naturalistic study.

Objective: To document the effectiveness and vicissitudes of treating 14 bipolar patients with lithium carbonate over a combined 300 years, and an average of 21 years/patient.

Methods: Chart review of the narrative and laboratory studies of these 14 patients ranging in duration from 12 to 29 years.

Results: Lithium stabilized these bipolar patients over these periods. Only three patients required hospitalization, one because lithium was slowly tapered at her request after 6 years of mood stability, another because of non-compliance, and a third because of co-morbid alcohol abuse. One patient attempted suicide after lithium was tapered off. However, in some patients, there were serious side-effects necessitating lithium discontinuation.

Conclusions: Controlled studies in psychopharmacology are obviously preferred to open-label or naturalistic case studies. However, controlled studies are rarely conducted over long periods, and practice-related naturalistic research can be of value, albeit anecdotal and without the use of structured rating scales. In this paper, we are reporting on 14 patients seen consistently by one psychiatrist. These patients were functional and productive at work and in family life. The patients suffered brief hypomanic or depressive episodes. Although several patients experienced serious side-effects, lithium was continued with stable mood, while the side-effects were managed in collaboration with other specialists.