Does effective lithium prophylaxis result in a symptom-free state of manic-depressive illness? Some thoughts on the fine-tuning of mood stabilization

Recovered depressive or manic-depressive patients on long-term lithium medication may show oscillations in their state of well-being, neuropsychological impairment, and subclinical mood disturbances. It remains an open question as to whether such changes should be labeled as “subthreshold” symptoms of depression or mania, as a particular syndromal entity not directly related to the “mood disorder,” or as subtle side effects of lithium. Within a psychological theory of the action of lithium, mental effects of lithium must be postulated and should not be simply considered as side effects. Depending on medical common sense and economic restrictions, the optimization and fine-tuning of lithium prophylaxis may be advisable in selected cases, including counseling, family therapy, cognitive therapy, well-being therapy, or interpersonal psychotherapy. Also, a change of medication may be considered in patients with subjective or objective cognitive impairment.¹

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