The authors used a systematic life-chart methodology to observe four
patients with bipolar disorder in whom long periods (6-15 years) of
effective lithium prophylaxis were followed by relapses on lithium
discontinuation. Once the drug was reinstituted, it was no longer
effective. The incidence, predictors, and mechanisms underlying this
phenomenon all require further systematic study. The current preliminary
observations suggest an additional reason for caution when lithium
discontinuation in the well-maintained patient is considered.