Discovery of Lithium:
Lithium utilization traces back to the mid-20th century. In 1949 an Australian psychiatrist named John Cade began experimenting with lithium salts, observing a profound “calming effect”. This led him to test lithium on patients with manic-depressive illness, now known as bipolar disorder, where he noted significant mood stabilization. This early work essentially paved the way for lithium to be incorporated into psychiatric practice. Given its history, we can consider lithium as one of the earliest mood stabilizers, thus transforming the landscape for the treatment of bipolar disorder.
Lithium is essentially a salt and can be found on the periodic table of elements. It has long been associated with psychiatric treatments, particularly for bipolar disorder. Despite its well-documented efficacy, lithium remains highly stigmatized and underutilized in modern psychiatry. This stigma, however, is largely unfounded and overlooks the broader benefits of lithium, both within and beyond psychiatric contexts. This blog will explore the multifaceted uses of lithium, address the misconceptions surrounding it, and highlight why it warrants renewed consideration in the mental health realm and maybe even in other areas of clinical practice.
First, we will discuss Lithium in Psychiatry:
Lithium’s primary claim to fame in psychiatry is its use as a mood stabilizer for bipolar disorder. It is actually considered the “Gold Standard” treatment for acute mania. There is also evidence to suggest it can prevent new depressive episodes in non-bipolar depression. It is one of only two medications to date that can actually reduce the risk of suicide. In addition to its clinical benefits, lithium is also a cost-effective treatment option as it is inexpensive in most situations.
Despite the availability of newer drugs, lithium remains unparalleled in its efficacy for preventing manic and depressive episodes. The exact mechanism by which lithium exerts its mood-stabilizing effects is still not fully understood, but it is believed to influence several neurotransmitter systems. One of the most significant advantages of lithium over other mood stabilizers is its long-term benefits. Continuous lithium treatment has been associated with a reduction in the recurrence of mood episodes, which is crucial for the long-term management of bipolar disorder. Unlike some medications that may lose effectiveness over time, lithium has been shown to maintain its efficacy, making it a cornerstone in long-term treatment.
Beyond Psychiatry:
Recent research has uncovered a range of potential benefits of lithium beyond psychiatric indications. New data suggests that lithium has a major neuroprotective effect, meaning it may actually slow neurodegeneration, offering potential benefits for conditions like Alzheimer’s disease and other forms of dementia. This broadened scope challenges the narrow view of lithium solely as a psychiatric medication and highlights its versatility.
Addressing the Stigma
The stigma surrounding lithium largely stems from misconceptions about its side effects and toxicity. While it is true that lithium requires careful monitoring to avoid toxicity, its side effects are manageable and often less severe than those of other mood-stabilizing medications. Another aspect of the stigma is the perception that lithium is an outdated drug, overshadowed by newer, supposedly more advanced treatments. However, this perception fails to recognize that newer does not always mean better. Lithium’s long track record of success and its unique properties make it an invaluable tool in psychiatry.
Safety Considerations:
Although there appears to be a multitude of positive benefits of lithium, it is crucial (as with any medication) to understand what safety measures you should take if you decide to trial this medication:
- Regular Blood Tests: Lithium levels in the blood must be monitored frequently to ensure they remain within the therapeutic range. Over time the frequency of labwork can decrease once stability is obtained.
- Kidney and Thyroid Function: These should be assessed prior to starting treatment and periodically afterward to ensure safety.
- Hydration: It is essential for individuals to maintain adequate hydration while taking lithium, remember, it is primarily a salt, and becoming dehydrated can lead to elevated blood levels.
- Medication Interactions: Lithium can interact with some medications such as NSAIDs (ibuprofen) and certain blood pressure medications. It is essential to tell your provider all of the medications and supplements that you take if you choose to start lithium.
- Side Effects: The most common side effects include a mild fine tremor, increased thirst, frequent urination, and at times some weight increase. Most side effects can be mitigated with a slow dosing schedule.
Conclusion
Lithium is a multifaceted drug with proven efficacy in treating bipolar disorder and reducing suicide risk, along with promising potential in neuroprotection and prevention of neurodegeneration. The stigma against lithium is largely unfounded and overlooks the significant benefits it offers. By reevaluating our perceptions and embracing the full potential of lithium, we can provide better outcomes for patients both within and beyond the realm of psychiatry.
References
Baldessarini, R. J., & Tondo, L. (2022). Testing for antisuicidal effects of lithium treatment. JAMA psychiatry, 79(1), 9-10.
Barroilhet, S. A., & Ghaemi, S. N. (2020). When and how to use lithium. Acta Psychiatrica Scandinavica, 142(3), 161-172.
Birch, N. J. (2023). Lithium in psychiatry. In Metal Ions in Biological Systems (pp. 257-314). CRC Press.
Haupt, M., Bähr, M., & Doeppner, T. R. (2021). Lithium beyond psychiatric indications: the reincarnation of a new old drug. Neural Regeneration Research, 16(12), 2383-2387.
Tondo, L., Alda, M., Bauer, M., Bergink, V., Grof, P., Hajek, T., … & International Group for Studies of Lithium (IGSLi). (2019). Clinical use of lithium salts: guide for users and prescribers. International journal of bipolar disorders, 7, 1-10.
Zivanovic, O. (2017). Lithium: A classic drug—Frequently discussed, but, sadly, seldom prescribed! Australian & New Zealand Journal of Psychiatry, 51(9), 886-896.
