Is Response to Prophylactic Lithium a Familial Trait?
J Clin Psychiatry 2002;63(10):942-947
© Copyright 2014 Physicians Postgraduate Press, Inc.
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Background: Selecting a drug according to
the treatment response in a relative has been widely accepted
advice in the management of mood disorders. However, this
recommendation has not been adequately substantiated in the
literature. We tested the hypothesis that response to long-term
lithium treatment is a familial trait.
Method: We compared response to long-term
lithium treatment in bipolar relatives of bipolar lithium
responders and bipolar controls. Twenty-four relatives with
bipolar disorder (as determined using the Schedule for Affective
Disorders and Schizophrenia-Lifetime version [SADS-L] and
Research Diagnostic Criteria [RDC]) were identified in families
of 106 patients with lithium-responsive bipolar disorder. A
consecutive series of 40 lithium-treated patients in a bipolar
clinic (meeting RDC and DSM-IV criteria for bipolar disorder)
served as a comparison group. Lithium response was evaluated on a
rating scale reflecting the quality and quantity of available
Results: The prevalence of unequivocal
response among the relatives was 67%, as compared with the
response rate of 35% in the comparison group (chi2 =
6.04, df = 1, p = .014).
Conclusion: This highly significant
difference in response between relatives and the control group
supports the view that the response to lithium prophylaxis
clusters in families.