The possibility that relapses in the placebo groups in these trials are induced by withdrawal of previous medication would make sense of the fact that it has proved impossible to demonstrate that people receiving modern drug treatment for manic depression do any better than those who don’t, or didn’t. Two important studies have examined rates of relapse in people with classical manic depressive symptoms prior to the 1950s.American psychiatrist George Winokur found the records of 100 patients admitted to a psychiatric hospital between 19 with an episode of mania and then followed them up through their hospital records.She will need dialysis, and a kidney transplant – a high price to pay for a really effective treatment.
They found that on average patients had 4 relapses over the subsequent 10 years, equating to a relapse rate of 20% a year.In the comparison between lithium, lamotrigine and placebo in people with mania it was 26% a year (10).Admittedly these figure include all relapses, and not just those severe enough to require hospitalisation.The sedative and slowing effects of lithium, although usually described as side effects, account for why lithium can help reduce arousal and activity levels in people with acute manic symptoms.
So there is nothing magic or specific about lithium’s action in manic depression.
Lithium will exert its characteristic effects in anyone, whether or not they have mania or manic depression.