Lithium (from Greek lithos, “stone”) is a chemical element in the periodic table that has the symbol Li and atomic number 3. In the periodic table, it is located in group 1, among the alkali metals.

Lithium in its pure form is a soft, silver white metal, that tarnishes and oxidizes very rapidly in air and water.  It is a natural trace element found in small amounts in all organisms including plants and animals and widely distributed on earth, with large amounts in rocks and sea water. The element serves no apparent vital biological function since animals and plants survive in good health without it.

It is not even known whether lithium plays a physiological role in any of these organisms, but nutritional studies in mammals have indicated its importance to health, leading to the suggestion that it be classed as an essential trace element.  Surprisingly, lithium has more uses than just batteries, lithium carbonate is  one of the most effective drugs for treating bipolar (manic-depressive disorder) and possibly other conditions. 

Indications For Use

Lithium’s ability to fully alleviate the symptoms of this devastating condition makes it one of the best and most widely used and studied medications. Lithium also helps reduce the severity and frequency of mania and may also help relieve or prevent bipolar disorder. Studies show that lithium can significantly reduce suicide risk. Lithium also helps prevent future manic and depressive episodes. As a result, it may be prescribed for long periods of time (even between episodes) as maintenance therapy.  The patient must be carefully monitored and blood levels of lithium measured during treatment.

Mechanism Of Action

Like the closely related metals sodium and potassium, when ingested, lithium readily enters cells throughout the body and takes part in cellular metabolism and other basic biological processes. Its effects may be due to transmembrane sodium exchange in nerve cells in the central nervous system (brain and spinal cord).

Doctors don't know exactly how lithium works to stabilize a person's mood, but it is thought to help strengthen nerve cell connections in brain regions that are involved in regulating mood, thinking and behavior. 

History

According to Walter A. Brown in his book  “Lithium: A Doctor, a Drug, and a Breakthrough,” the use of lithium in psychiatry goes back to the mid-19th century. Early work, however, was soon forgotten, and John Cade, an Australian psychiatrist is credited with reintroducing lithium to psychiatry for mania in 1949.

Although psychopharmacology is now an indispensable feature of contemporary life, John Cade’s lithium discovery represented a radical departure from the prevailing ideas about the treatment of mental illness. It was the first demonstration that a drug can alleviate the fundamental symptoms.  A crucial experiment on guinea pigs prompted him to take lithium himself, and eventually he tested it in manic patients. Cade’s life brought him to the point where — equipped with neither research training nor research funding, working from a makeshift laboratory in an unused kitchen on the grounds of a small, isolated mental  asylum — he set out to find the cause of, and cure for, manic-depressive illness. In Cade’s day, the first half of the 20th century, most doctors believed that people with a chronic severe mental illness had a disease that was largely hereditary and that involved a brain abnormality. Other than electroshock for depression, there were no effective treatments.

The customary therapy for these patients was to confine them in asylums indefinitely or until the condition spontaneously improved. Drugs with stimulating or sedating properties, amphetamines, opiates and bromides among them, were administered with little benefit and no effect on the characteristic symptoms of the illness.

A Danish psychiatrist named Mogens Schou was the other major figure in the lithium story. In 1953, having recently joined the staff of Denmark’s Aarhus University Psychiatric Hospital as a research associate, Schou was looking for a project. His chief, intrigued by Cade’s lithium work, suggested that Schou investigate the claim that lithium alleviates the symptoms of mania. At that point, although the lithium studies from Australia certainly seemed to show that lithium curtails mania, they did not provide definitive proof; such proof, and lithium’s acceptance as a treatment, required “controlled” research in which lithium was compared with no treatment, a placebo or a different treatment. Schou set about to do just that sort of research. In a series of methodical studies, Schou and his collaborators confirmed that lithium is in fact an effective treatment for mania.

More importantly, Schou and his collaborators showed that lithium can prevent episodes of both mania and depression. This prophylactic effect of lithium is recognized today as its most important benefit, and Cade readily acknowledged Schou’s contributions.  Schou’s work provided the basis for lithium’s acceptance as a treatment. It was widely confirmed by other researchers and has been validated by more than five decades of clinical experience.

Final Thoughts

Lithium was not approved for medicinal treatment of mania until 1970, and it was not approved for prevention of recurrent mania until 1974. To date, the Federal Drug Administration still does not approve of lithium usage to prevent depression.

Max Sherman is a medical writer and pharmacist retired from the medical device industry. His new book “Science Snippets” is available from Amazon and other book sellers. It contains a number of previously published columns.  He can be reached by email at  maxsherman339@gmail.com.