General

Lithium is a non-addictive, mood-leveling poison used in very small doses to mitigate the more extreme thoughts and behaviors that occur in psych patients diagnosed with bipolar disorder (manic depression). Precisely how it works is still unknown, and what is known involves a lot of neuro-bio-chemical stuff involving all sorts of impressive-sounding names, the exact function of which are still very poorly (if at all) understood by neuroscientists.

Upon ingestion, lithium becomes widely distributed in the central nervous system and interacts with a number of neurotransmitters and receptors, decreasing norepinephrine release and increasing serotonin synthesis.
. . . . . .
The precise mechanism of action of Li+ as a mood-stabilizing agent is currently unknown.—Wikipedia, “Lithium pharmacology“

It is also used to treat a few other disorders and diseases, including antidepressant-resistant unipolar depression.

Lithium is actually a soft metal, first discovered in 1817 and first isolated in its pure form in 1818. Lithium salts naturally occurring in springs were used to treat mental disorders at least as early as AD 200 by the Greek physician Galen (or Soranus of Ephesus, not sure). Lithium was approved by the US FDA for use in the treatment of manic depression in 1970 and is still administered as medication in the form of lithium carbonate or lithium citrate. Interestingly, it was in using lithium carbonate as a substitute for table salt that the lethality of higher doses of lithium was discovered.

It wasn’t until the late 19th century that the medical benefits of lithium were rediscovered. Carl Lange and William Alexander Hammond (independently) began looking into lithium as a treatment for illnesses they believed to be caused by an excess of uric acid. When they observed that lithium calmed excitable patients, they began to use it to treat mania.

But it’s John Cade who is credited with the “discovery” of lithium’s effect on mania. In 1949, he published the first paper on the use of lithium as a psychiatric drug. The irony is that he was also operating under the (false) theory that mania was caused by an excess of urea. But, hey, he published the paper, so he gets all the credit.

Lithium on the Brain

A recent UCLA study finds that lithium therapy actually increases grey matter in the areas needed for attention and controlling emotions:

“Although other studies have measured increases in the overall volume of the brain,” Bearden said, “this imaging method allowed the researchers to see exactly which brain regions were affected by lithium.”
. . . . . .
“Unfortunately,” said Bearden, “there is no evidence that the increase in gray matter persists if lithium treatment is discontinued.”

This is where I found the link to this study.

And here is the main page of that site.

My Experience

It’s been a little more than a year now since I switched from lithium to Lamictal to control my mood swings. So far, so good. I am alert, productive, and think clearly on most days. Of course I still have ups and downs in response to various stressors, and until now have not really been able to read anything terribly complicated (like philosophy or serious history) or write anything at all (as you might notice from the entry dates on this blog). But much of that is because of my own stubbornness in refusing to seek treatment, in the form of not wanting to try to find a new psychiatrist even though I was on the depressed side of things.

The switch from lithium to a different mood stabilizer seems common, with lithium being the drug of first choice to quell the turmoil during a severe episode or at the very beginning of treatment for those who have only recently been diagnosed. Most patients begin a different drug regimen once the severe symptoms subside, switching to the newer alternative medications to avoid the long-term side-effects possible with lithium.

Unfortunately, to many people (probably most) the use of lithium is still controversial and stigmatized. It still conjures horrific images of crazy people in asylums and patients becoming zombies, but it is still the most effective mood stabilizer out there. The psychiatric profession, bowing to the pressures of common misconceptions, the ignorance of non-specialists, and the interests of the pharmaceutical industry, avoided its use once alternatives were developed. Medical research concentrated on the risks and disadvantages of taking lithium and touted the miraculous results in studies of the newer drugs.

But problems with the newer medications began to surface over time. The alternatives to lithium span from anti-seizure drugs to atypical anti-psychotics, the use of which was (and still is in some cases) a so-called “off-label” use, a practice that can present ethical issues. But in most cases, the drugs used are widely accepted alternatives, and they are effective and safe.

Lithium does have some serious side-effects, and the blood lithium levels of those who take the drug must be closely monitored. However, many of the side-effects of other medications used as mood stabilizers are just as harmful and inconvenient as those of lithium, and can also result in death in the case of overdose. And, while the effects of the long-term use of lithium can be scary, there is very little research on the effects of long-term use of alternatives because the medications have not been in use long enough to know what they might be.

Psych patients should be closely monitored regardless of the medication used, and each individual will respond differently to each medication. Some mood stabilizers make some people anxious, some drowsy, some forgetful, some even drool, along with the more serious effects like seizures or deadly rashes (seriously, Lamictal can cause both). Others may work wonders for some, but not at all for others. The therapeutic processes of mood stabilizers is less understood for other psychiatric medications than for lithium. In fact, because of lithium’s age, its effects on the brain and body are better known.

There is no debate that much more is known about lithium than its alternatives. Its use is once more the first choice in treatment of bipolar disorder, and is now often used to compliment SSRIs, especially in the treatment of drug-resistent unipolar depression. Again, it is unfortunate that there is still a stigma attached to the drug and those who use it.

One of the comments on this blog is, “lithium is crap- every person on it is a guinea pig” The fact of the matter is that any and all psych patients are guinea pigs, their own if they refuse treatment, and society’s no matter which medicine they take or treatment they accept.

UPDATE:

When I was on lithium, I felt like my brain had been wrapped in a layer of cotton. Nothing really got through without being completely toned down, which is somewhat the point, but there is a very delicate balance. In one of her books, Kay Redfield Jamison says that she basically stays on the smallest dose that is effective for her. But she also says that because she takes the minimum, she does have small relapses.

It was because of lithium’s brain-dulling quality that got off of it and onto Lamictal. I was on Lamictal alone for a couple of years, then when my doc tried to up my dose, my body completely freaked out and I ended up in the ER. Overall, Lamictal never really worked as well as lithium. Now I’m on both lithium and Lamictal, and it seems to be working really well. The lithium/Lamictal combination seems to be a pretty popular one right now (in vogue in psychiatric circles), and I do think it might be a good one.

Latest update on me and lithium follows in the comments.