Lithium Prophylaxis in American Patients With Unipolar Disorder-Reply

In reply  Our recent review' of pharmacotherapy and ECT in the treatment of mood disorders covered new research during the period between August 1991 and August 1992. We are not aware of studies published during this period that examined the efficacy of lithium monotherapy as a continuation or maintenance treatment for unipolar depression. Dr Schou questions why lithium is not more frequently considered in the United States in this capacity. One explanation may be that current practice recommendations² are that patients receive as continuation and maintenance therapy the same medications to which they responded during the index episode. Indeed, there is some evidence that the dosage during maintenance treatment should be the same as that given during acute-phase treatment.³ Since lithium monotherapy is rarely recommended in the acutephase treatment of unipolar depression,⁴ it would be unlikely that patients would receive such monotherapy as continuation or maintenance treatment.With ECT