included the first three of these studies
[45–47] together with two earlier studies [48,49] in a metaanalysis
for the evaluation of lithium. These studies were characterized
by pure samples of bipolar patients and by study patients
being maintained and stabilized on lithium for no more than
3 months prior to randomization, and lithium was confirmed to be
statistically significantly superior to placebo [44]. However, the effect
size (2-years’ relapse/recurrence rates of 40% and 60% on
lithium and placebo, respectively) was less than reported in earlier
analyses [4,50], partly due to the inclusion of the essentially
failed RCT by Bowden et al.