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Published Online:https://doi.org/10.1176/ajp.125.4.499

A longitudinal double-blind study of two manic patients treated in a random fashion with lithium carbonate and placebo is reported. Daily ratings of mania were recorded independently by a trained psychiatric nursing team and by a psychiatrist. The major finding was a definite increase in mania, reflected in the daily ratings, during placebo periods within 24 hours of the withdrawal of lithium, even when the placebo period lasted only one day. The rapidity and predictability of the response to withdrawal of lithium offers important advantages both in the clinical use of this drug and in its use as a research tool.

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