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                  <text>June 13, 1979
Joyce G. Small, M.D.
Larue D. Carter Memorial Hospital

Indianapolis, Indiana

h6202

Dear Joyce,
Thank you for the copies of the progress report on ECT and
the preprint on the lithium-BOT study. I found both interesting and
useful. If I understand the ECT-drug study, so far the ECT alone,
drug alone and combined treatments are equally effective with son:
advantage for the combined drug—ECT combination. I do hope that these
findings are examined further.
The lithium study is quite stimulating. The data are the.
basis for a prospective study witch needs to be done. I found three
citations that I missed (Hoenig &amp; Chaulk, Ray, and Remick)-- and I thank
you for bringing these to my attention. I believe that the cautions
you recommend (not to use ththium and ECT together) are good ones, and
I will adopt them, until further data are developed. (While the other
combination, lithium and haloperidol [or chlorpromazine] is controversial
as to its toxicity, as a therapeutic conservative, I still do not like to
use the two together, and so teach my students).
Many thanks. My regards to Iver and
help in teaching in the two courses in Chicago.

my

thanks for his

Sincerely yours,
Fink, M.D.
Professor of Psychiatry

Max

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