نبذة مختصرة : Background: Time to a new episode of bipolar disorder (BD) is shorter after discontinuing lithium rapidly. We now address this and other factors associated with the risk of early illness after discontinuing lithium.
Methods: We compared factors for association with recurrences of BD within 12 months of discontinuing long-term lithium treatment, using bivariate and multivariable analyses, as well as survival analysis to evaluate latency to new episodes versus rate of lithium-discontinuation and prior treatment duration.
Results: Among 227 BD subjects who received lithium for 4.47 [CI: 3.89-5.04] years and then discontinued, rapid treatment-discontinuation, and stopping for medical reasons were strongly associated with new illness-episodes within 12 months, as were diagnosis (BD-I > BD-II), greater morbidity during lithium-treatment, and less education, but neither longer treatment nor serum lithium concentrations. Discontinuation rate was strongly associated with shorter median latency to a new episode (rapid: 3.50; gradual [≥2 weeks]: 10.6 months), even with very early recurrences excluded to avoid potential contributions of emerging illness to treatment-discontinuation. Early recurrence was not associated with treatment-duration of ≥2 or ≥5 years or less. In multivariable logistic regression, rapid discontinuation, stopping for medical reasons, and BD-I diagnosis remained significantly, independently associated with early illness after lithium-discontinuation, with no effect of treatment duration.
Conclusions: Early recurrence risk was again much greater after rapid discontinuation of lithium and discontinuing for medical reasons, somewhat greater with BD-I than BD-II, and following greater morbidity during lithium-treatment, but not related to dose or duration of preceding treatment exposure.
(© 2022 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)
References: Cosci F, Chouiard G. Acute and persistent withdrawal syndromes following discontinuation of psychotropic medications. Psychother Psychosom. 2020;89:283-306.
Biel MG, Peselow E, Mulcare L, Case BG, Fieve R. Continuation versus discontinuation of lithium in recurrent bipolar illness: a naturalistic study. Bipolar Disord. 2007;9:435-442.
Baldessarini RJ, Tondo L. Effects of treatment discontinuation in clinical psychopharmacology. Psychother Psychosom. 2019;88:65-70.
Tondo L, Vázquez GH, Baldessarini RJ. Prevention of suicidal behavior in bipolar disorder. Bipolar Disord. 2021;23:14-23.
Viguera AC, Whitfield T, Baldessarini RJ, Newport DJ, Stowe Z, Cohen LS. Recurrences of bipolar disorder in pregnancy: prospective study of mood-stabilizer discontinuation. Am J Psychiatry. 2007;164:1817-1824.
Faedda GL, Tondo L, Baldessarini RJ, Suppes T, Tohen M. Outcome after rapid vs. gradual discontinuation of lithium treatment in bipolar mood disorders. Arch Gen Psychiatry. 1993;50:448-455.
Baldessarini RJ, Tondo L, Floris G, Rudas N. Reduced morbidity after gradually discontinuing lithium in bipolar I and II disorders: a replication study. Am J Psychiatry. 1997;154:551-553.
Viguera AC, Baldessarini RJ, Hegarty JM, Van Kammen D, Tohen M. Clinical risk following abrupt and gradual withdrawal of maintenance neuroleptic treatment. Arch Gen Psychiatry. 1997;54:49-55.
Baldessarini RJ, Tondo L, Ghiani C, Lepri B. Discontinuation rate vs. recurrence risk following long-term antidepressant treatment in major depressive disorder patients. Am J Psychiatry. 2010;167:934-941.
Tiihonen J, Tanskanen A, Taipale H. 20-year nation-wide follow-up study on discontinuation of antipsychotic treatment in first-episode schizophrenia. Am J Psychiatry. 2018;175:765-773.
Harrow M, Jobe TH, Tong L. Twenty-year effects of antipsychotics in schizophrenia and affective psychotic disorders. Psychol Med. 2021; [on-line ahead of print, 8 Feb, pp 1-11]. doi: 10.1017/S0033291720004778.
de Vries C, van Bergen A, Regeer EJ, Bentham E, Kupka RW, Boks MPM. Effectiveness of restarted lithium treatment after discontinuation: reviewing the evidence for discontinuation-induced refractoriness. Bipolar Disord. 2013;15:645-649.
Brissos S, Ruiz Veguilla M, Taylor D, Balanzá-Martinez V. Role of long-acting injectable antipsychotics in schizophrenia: a critical appraisal. Ther Adv Psychopharmacol. 2014;4:198-219.
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