• Introduction & Key Points
• Indications for Lithium
• Dosage and administration
• Averse effects of lithium
• Pharmacokinetics and serum concerntrations
• Baseline tests and monitoring
• Drug interactions
• Continuation and maintenance treatment
• Cautions and contraindications to lithium treatment
• Cases
• References
• Issue 3 Contents

Continuation and maintenance treatment

There is debate in the literature about how long mood stabiliser treatment should be continued and various criteria have been proposed. Local consensus is to continue treatment for at least six months after a first manic episode. The criteria for long-term maintenance treatment varies but commonly includes at least two episodes of mania or depression.¹

Discontinuing lithium treatment

Discussion about discontinuing lithium treatment will usually be done in consultation with a specialist. Indications for discontinuing treatment include:

• Lack of response, given an adequate dose for an adequate time period.
• Renal failure or worsening renal insufficiency.
• Cardiac insufficiency.
• Ongoing poor compliance with medication (where interventions to improve compliance have been ineffective).
• Intolerable adverse effects to lithium.
• Remission of bipolar disorder for an adequate period of time in liaison with specialist (see below).

Early relapse of bipolar disorder (particularly mania) may occur after discontinuing lithium treatment. If it is withdrawn in under two weeks, the risk of relapse within the next three months is much higher than with slower withdrawal. Lithium should be reduced slowly over at least two weeks (ideally over four weeks) when being discontinued.