Discontinuation of lithium augmentation in an elderly cohort

Objectives To observe the effects of gradual discontinuation of lithium augmentation therapy in a group of patients over the age of 65 years and to measure the rate of relapse and to identify any factors which would predict relapse. Methods This was a naturalistic study involving 21 patients who were on lithium augmentation and whose lithium was discontinued for a variety of clinical reasons. In most cases lithium was tapered and discontinued over a period of 2–12 weeks. Demographic and other variables were collected at baseline and compared between those who remained well and those that subsequently relapsed. Results Eleven patients (52.4%) relapsed following discontinuation of lithium augmentation. Those who relapsed had been on lithium for significantly longer than those who remained well off lithium ( p  = 0.007). There was a trend towards more hospital admissions in the relapse group ( p  = 0.062). Conclusions When lithium augmentation therapy is discontinued in elderly depressives over half of these patients relapse. A longer duration of prediscontinuation lithium treatment and more hospital admissions appear to be associated with increased risk of relapse. Copyright © 2001 John Wiley & Sons, Ltd.