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Excerpt 2
James W. Jefferson, MD and John H. Greist, MD

Lithium & Bipolar Disorder: A Guide

(Excerpt 1)

Does lithium cure bipolar disorder? No, but it can be effective in controlling it. There are currently no permanent cures for bipolar disorder, and its cause(s) are not well understood.

For people suffering from the disabling mood swings of bipolar disorder, lithium may be of help in two ways:

1. Stopping an acute episode—Lithium can help a person out of a state of mania back to a normal state. (Lithium may also be effective in some cases of acute depression.)
2. Preventing further episodes—Lithium can help prevent episodes of mania and depression from recurring.

The fact that lithium acts to control rather than cure bipolar disorder is important. It means that if successfully treated people stop taking lithium, manic or depressive episodes will be more likely to occur.

Controlling rather than curing a disorder with a specific drug is actually a common practice. A well known example is the use of insulin to control certain forms of diabetes. Insulin does not cure the underlying disease of diabetes, but it does help to control symptoms so that the diabetic patient is able to live a more normal life. If the insulin is stopped, symptoms of the disease reappear. Although insulin helps control many symptoms and prevent many of the damaging effects of the disease, the diabetes itself is still present. Other examples of diseases controlled with medication are high blood pressure, heart failure, hypothyroidism and arthritis.

Many people with bipolar disorder experience frequent episodes of mania and depression before beginning treatment with lithium. If they improve on lithium and then stop taking it, they will almost certainly have frequent episodes again. The bipolar disorder would no longer be controlled.

Some people with bipolar disorder experience infrequent episodes of mania and depression—sometimes years apart. Others have only one or a few such episodes and no further recurrences. Why this happens is as much a mystery as the cause of the illness itself. With infrequent episodes, continuous use of lithium may be unnecessary. However, since the course of the illness is difficult to predict, it is very important that patients discuss the possibility of future manic or depressive episodes with their doctor before deciding to stop taking lithium. Episodes that occur after the drug is stopped are likely to respond when the drug is restarted, but this may not always be the case. Because episodes of mania and depression can have a devastating effect on a person�s life, long-term treatment (sometimes lifelong) is often indicated.