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The objective of this study is to determine if a brief course of lithium carbonate is safe, well tolerated, and effective for long term prophylaxis of recurrence of depression in chronic schizophrenic outpatients. The study is being conducted in two phases: an open label (OL) Phase I with 4-weeks treatment and a 3-month, double-blind placebo-controlled (DBPC) Phase II to examine the efficacy of lithium. After completing the OL Phase, patients who respond to 4 weeks lithium treatment are eligible to enter the DBPC Phase. This is a multi-center, double-blind, placebo-controlled study with a projected total sample size of 200 subjects. Outpatient volunteers with a history of chronic schizophrenia (DSM-III-R) and a diagnosis of current nonpsychotic major depressive disorder are eligible for the study. Following a one-week, single-blind placebo lead-in, patients will be randomly assigned to lithium or placebo for a period of 6 months. Following the lithium lead-in period, patients who respond to lithium are eligible to enter the DBPC Phase. Safety, tolerability, and antidepressant efficacy will be assessed throughout the 6 months of the study. The final study analysis will examine the long-term effects of lithium (3 to 6 months post final treatment) and the DBPC Phase. The study has enrolled 33 subjects to date. The patients entered have a mean age of 40.3 years with a mean dose of 1728 mg/day. The mean HAM-D scores at entry were 24.4 with range from 17-34. These symptoms were successfully treated with the single blind lead-in period. During the follow-up period all subjects except one discontinued lithium as defined in the study protocol. No subjects experienced significant unwanted effects. Fourteen of 19 completed the study (with 3 dropping due to loss to follow up), and 9 were lost to follow up. This is in contrast to the 20 subjects (2 drop-outs) in the placebo group. Our results show that lithium can be used as a prophylactic agent in patients with chronic schizophrenia, as well as many patients with primary depression.