Letter to the Editor
Sir: In their discussion, Frye et al. failed to account for
several crucial effects that undermine the results of their study
that compared valproic acid and lithium.
First, because every patient taking lithium was also taking a
neuroleptic and a benzodiazepine at hospital discharge, the
study population was lithium-resistant. Lithium resistance is also suggested by the long duration of illness prior to hospitalization.
Simply, lithium does not work in lithium-resistant patients,
and subject selection biased the results against lithium.
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