Inappropriate Use of Lithium in the Treatment of Reactive Depressive Cycles

Abstract

Lithium carbonate has been shown to interrupt manic episodes and is reported to have a prophylactic effect on depressive episodes, i.e. if taken regularly it should decrease or prevent depressive affective swings¹. Although there is not yet official approval for the latter use in the USA, some practitioners have tried lithium treatment for patients with histories of repeated depressions who have responded poorly to a trial of psychotherapy. Working in a university medical centre, the author has been referred a number of such patients whose repeated depressive episodes were not primarily cyclical biochemically but represented cyclical interactional patterns with secondary affective changes. In this situation there was an obvious danger of obscuring, to the physician and the patient, the psychotherapeutic treatment of the interactional pattern, by focusing on the medical management of the apparently biological affective swings.