Has the effectiveness of lithium changed? Impact of the variety of lithium's effects

Lithium treatment, initially considered specific for bipolar disorder, has since been shown to provide additional benefits in affective and other disorders. This variety of benefits should be taken into account when interpreting recently reported lower efficacy during lithium prophylaxis, as well as early relapses and loss of efficacy after lithium discontinuation, There are particularly striking parallels between these recent reports and earlier observations of "antipsychotic" lithium effects. Other factors, such as the accumulation of atypical, treatment-resistant patients in academic centers and, in particular, the broadening of diagnoses of affective disorders, further complicate the interpretation of the recent reports. Lithium, however, continues working well for patients with typical bipolar disorders,for whom it was originally proved effective. (C) 1998 American College of neuropsychopharmacology. Published by Elsevier Science Inc.