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How Can Lithium Help Against Bipolar Depression?

Being discovered as a potential medicine in 1949 by John Cade, a psychiatrist from Australia, lithium is nowadays the mainstay of the treatment for manic-depressive illness, also known as bipolar depression. The authors of the Pill Book even called this medication “the only effective anti-manic drug” (The Pill Book, 12th

Edition, Bantam Books, p.642). The medications, based on lithium carbonate (Eskalith, Lithane, Lithobid, Lithotabs) or lithium citrate (Lithonate or generic), help people with bipolar depression reduce the number and intensity of recurrences; lithium is especially helpful in treating manic episodes of the illness.

It is interesting to note that lithium is not a chemical compound, synthesized by scientists, who wanted to find the medication to treat bipolar depression. Lithium is a naturally occurring element, and though it is soft enough to be cut with a knife, lithium belongs to a group of metals. Its therapeutic qualities were first discovered in 1950th, but it took about 20 years for the initiation of the first clinical trials of lithium use in manic-depressive illness treatment.

In spite of the fact that lithium belongs to the most effective and widely used means to control manic episodes, the exact mechanism of lithium action remains unknown. 

The label of one of the approved lithium medications gives the following explanation of its mode of action: “Preclinical studies have shown that lithium alters sodium transport in nerve and muscle cells and effects a shift toward intraneuronal metabolism of catecholamines, but the specific biochemical mechanism of lithium action in mania is unknown”. 

Well, taking into account that the whole complex of biochemical reactions in human brains is explained with one sentence, it looks obvious that scientists have not yet understood clearly what exactly lithium does in order to prevent manic-depressive illness. On the other side, the line of chemical reactions in brains, which turns one of the Earth elements into a treatment option for manic episode, is not so important for patients after all.

From the practical point of view the most important thing about lithium is that it does work. I do not think that many of us understand clearly how cell phone works, but we still use these gadgets daily, aren’t we? Same story with lithium – people do not understand how it works, but they know that it really works. And that seems to be enough for the time being…

For practical use, it is important that lithium can reduce such manic symptoms, as elation, rapid speech, hyperactivity, aggressiveness, hostility, poor judgment, etc. By the way, many clinical studies showed high effectiveness of lithium in treating patients with bipolar depression. Thus, it is said that about 78 % of one study participants had a good response to lithium (comparing to only 40 % of patients, who received placebo pills).

On the other hand, it should be mentioned that lithium is rarely used as the only treatment for acute bipolar depression. It is because it takes some time for lithium to change the improper chemical balance in brains, which is responsible for rapid and significant mood swings from depression to mania and vice versa. This period may vary from a few days to a couple of weeks. Hence, patients with acute manic symptoms require additional treatment in combination with lithium.

It is worth to mention that lithium may turn into poison very quickly: therapeutically useful doses of lithium (0.6 to 1.2 mmol/l) are just slightly lower than toxic amount of this element (above 1.5 mmol/l). That is why the whole treatment process should be carefully monitored by a doctor and patients should never experiment with different doses of lithium, since it may have serious consequences.

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Finally, to end up the story of lithium it is worthy to mention that humans sometimes use treatment options, which seem to be extraordinary or even dangerous at the first sight – think about snake poison, bee bites, or even X-rays; however, when used correctly these means offer the solutions to many health disorders, which are next to impossible to treat with the artificial medications. It seems that lithium is one the examples of remedies, offered by Nature. It is only a pity that Mother Nature did not supply us with the label for this remedy…


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