Pharmacodynamic stressors are probably associated with discontinuation of maintenance treatments with medicinal agents, especially with abrupt discontinuation. In agreement with Dr Moncrieff, such an iatrogenic factor may contribute to drug vs placebo differences in recurrence risks in experimental therapeutic trials involving lithium therapy for bipolar disorders. The concept of relapse risk after drug discontinuation has growing support, and considers the proposition that stopping treatment is not the same as not treating.1,2 This factor may confound interpretation of at least some of the difference in many controlled therapeutic trials that typically involve drug discontinuation.2
Baldessarini RJ, Tondo L, Viguera AC. Forty Years of Lithium Treatment—Reply. Arch Gen Psychiatry. 1998;55(1):93. doi:10.1001/archpsyc.55.1.93
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