Five-Center Study Clarifies Use of Lithium, Imipramine for Recurrent Affective Disorders
Robert F. Prien Ph.D.1
1 National Institute of Mental Health; Room 1OC-06, NIMH, 5600 Fishers Lane, Rockville, Maryland 20857
This collaborative study suggests the following guidelines for practice:
Lithium is the treatment of choice for the long-term preventive treatment of bipolar disorder. The use of imipramine for this group of patients is not recommended because of the high risk of a manic episode.
There appears to be no advantage to combining imipramine with lithium for maintenance treatment of bipolar patients.
Lithium therapy is especially indicated for bipolar patients whose last episode is manic.
For unipolar patients whose index episode is of moderate Severity, lithium and imipramine are equally effective. However, the results strongly suggest that lithium is relatively ineffective in preventing severe unipolar depression.
There is no advantage in combining lithium and imipramine in preventive maintenance treatment of unipolar depression.
Because of its strong antimanic properties, lithium may be of value in maintenance treatment of unipolar disorder where there is a suspicion of a latent bipolar disorder or first-degree relatives with a history of bipolar illness.
