Reply to Letter to the Editor "Lithium Therapy for Corticosteroid-Induced Mood Disorder"

Letter to the Editor

Sir: We appreciate the comments on our article by Dr. Terao and would like to respond to several issues he has raised. He concluded that lithium should be used carefully for patients with corticosteroid-induced mood disorder, even if renal dysfunction or hypothyroidism coexists. We do not regard lithium as first-line treatment for patients with significant renal disease, in accordance with the warning clearly stated in the prescribing information for lithium. Carbamazepine and valproate showed substantial effectiveness for corticosteroid-induced mania in our series. We have been presented with 2 additional single episode cases of corticosteroid-induced hypomania in which patients were effectively treated with valproate. Carbamazepine and valproate have proven effectiveness comparable to that of lithium for patients with primary mania. Although we do not consider lithium to be absolutely contraindicated for patients with renal disease, carbamazepine or valproate should be a first-line treatment. If neither carbamazepine nor valproate is effective, lithium treatment may be undertaken with extreme caution, including daily serum lithium determinations and dose titration. Antipsychotics are another treatment option for corticosteroid-induced mania.