Friday, September 9, 2016

Lithium & Bipolar: Flamingo & Atacama Survival!

It has always been a dream of mine to visit Atacama.


"The desert? Where they filmed James Bond?" 

My friends were incredulous. 

"I will take some good photos!"

"In the desert?"

There was a period when I would not put up any picture with blue skies. 

Too cliché. 

"Maybe I won't do any with greens of any kind this time!" I joked. 

As it turned out, it was not difficult at all and in Atacama, we actually met one of their rare rainstorms.

As one of the firm advocates of Lithium, he thought he needed to be where much of the world's Lithium could be cheaply produced.

As a lover of wild life he soon finds himself in a difficult position especially as much of the Lithium would be used in batteries for cars such as the $100,000 plus Tesla and your iPhones and Tablets.

Chile could produce lithium cheaply by using water and in a desert where the water is scarce this creates a problem: especially for the Flamingos. A third of the lake water is now used for extracting the Lithium.

All photos © Am Ang Zhang 2015

There is a view that the water will run out and with that the Flamingos will perish. Just a worry especially as The Cockroach Catcher was not sure if any Lithium will be left for Manic Depressives (Sorry: Bipolars!)

The Cockroach Catcher was privileged to be working with an Australian trained psychiatrist when he started in psychiatry in 1969. It was the first time that I have encountered Lithium and Manic-Depressive psychosis (still my preferred name than Bipolar Disorder as Bipolar seemed easier for parents to accept, hence my objection).

I feel it was appropriate to honour Cade for his work on Lithium during my recent visit to Australia.

Cade, John Frederick Joseph (1912 - 1980)
Taking lithium himself with no ill effect, John Cade then used it to treat ten patients with chronic or recurrent mania, on whom he found it to have a pronounced calming effect. Cade's remarkably successful results were detailed in his paper, 'Lithium salts in the treatment of psychotic excitement', published in the Medical Journal of Australia (1949). He subsequently found that lithium was also of some value in assisting depressives. His discovery of the efficacy of a cheap, naturally occurring and widely available element in dealing with manic-depressive disorders provided an alternative to the existing therapies of shock treatment or prolonged hospitalization.

In 1985 the American National Institute of Mental Health estimated that Cade's

discovery of the efficacy of lithium in the treatment of manic depression had saved 

the world at least $US 17.5 billion in medical costs.

But the sad truth is that it was really 15 years before the world embrace lithium and that means more lives could have been saved.

Toxicity: This is one of the main reasons that many new psychiatrists shy away from it.
Yet many lives could have been saved and in medicine one is always trying to balance the benefit and adverse effect of any treatment.

I cannot do better than to quote one of the best articles about Lithium & its toxicity.

Neuropsychopharmacology (1998) 19, 200–205. doi:10.1016/S0893-133X(98)00019-0

Gordon Johnson MB, BS, FRANZCP, FRCPsych, DPM

The report of the effectiveness of lithium in the treatment of mania by John Cade was followed by a number of studies confirming his observations and developing guidelines for safe and effective use. Premature rejection of lithium on safety grounds denied many patients the benefit of treatment and may have cost more lives than it saved. A similar safety alarm was triggered by reports of kidney damage in the late 1970s. Subsequent reports have questioned the significance of anatomical findings, and functional impairment and relationship to lithium treatment. Recent findings support the conclusion that progressive impairment of glomerular and tubular function in patients during lithium maintenance is the exception rather than the rule and is related more to lithium intoxication, maintenance plasma lithium levels, concurrent medications, somatic illness, and age than on time on lithium. Guidelines for lithium use and monitoring of renal function are outlined here>>>>.

Bipolar disorder: divalproex er vs placebo
May 19, 2009

Just before I retired, it has become fashionable to use anticonvulsants as a mood stabiliser. Being a traditionalist, I felt then that the evidence was not clear and I tended to stick with the trusted lithium.

Well my doubts were confirmed:Journal of the American Academy of Child & Adolescent Psychiatry:

A Double-Blind, Randomized, Placebo-Controlled Trial of Divalproex Extended-Release in the Treatment of Bipolar Disorder in Children and Adolescents.

Conclusions: The results of the study do not provide support for the use of divalproex ER in the treatment of youths with bipolar I disorder, mixed or manic state. Further controlled trials are required to confirm or refute the findings from this study. J. Am. Acad. Child Adolesc. Psychiatry, 2009;48(5):519-532.

An earlier Harvard study showed that Lithium reduced suicide risks by as much as 9 fold.

Latest: The Guardian.

“Lithium is a drug with a bad reputation. It is seen by patients, and some psychiatrists, as a dangerous drug. People rightly have suspicions about it. Patients say that the downsides include emotional numbing – feeling that you aren’t connected with your feelings – as well as tremors,” said Dr Joseph Hayes, a psychiatrist at University College London.
But lithium’s reputation is largely misplaced and based on the experiences of patients from the 1960s to the 1980s who were given too large a dose of the drug, he added. The new research, published in the medical journal PLOS Medicine, found that the side-effects of the mood-stabilising alternatives used by most patients are either the same as or worse than lithium, Hayes said.
Lithium for Manic-Depressive Disorder (Bipolar Disorder):                                         

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