Background and Aims:
Lithium salts continue being the most important treatment of bipolar disorder (BD). A major problem to achieve its effect is to achieve treatment adherence, because reduced adherence is associated with bigger morbidity. Depressive symptoms in bipolar patients are the most common and difficult-to-treat ones. The effect of lithium on manic and hypomanic episodes is well established but its effect on depressive-mixed episodes has not been already measured. Tha aim of the sudy was to assess the effectiveness of lithium salts in preventing depressive symptoms, in a sample of bipolar patients followed-up during 10 years, considering the adherence to treatment.
Methods:
Seventy-two patients with BD treated with lithium carbonate were included and followed-up during 10 years. Every 8 weeks a trained psychiatrist assessed their morbidity. Adherence was rated as good when more or equal than the 90% of bimonthly serum lithium assays remained ≥0.50mEq/L and was verified with the “Lithium Attitudes Questionnaire” score. 
Results:
Fifty-six patients (77.8%) were considered as good adherent. Those patients had significantly less episodes with depressive symptoms, required less hospitalizations during the follow-up, and a longer time to relapse than non-adherents.
Conclusions:
In addition to its known role in the management of mania and hypomania, lithium salts have also a preventive effect of the occurrence of depressive symptoms in the long-term of BD.  Treatment adherence should be addressed in order to translate the efficacy of treatments into effectiveness in clinical practice.

02 - CAN LITHIUM SALTS, IN REAL LIFE, PREVENT DEPRESSIVE-MIXED EPISODES? DATA FROM A LONG PROSPECTIVE FOLLOW-UP