Sunday, February 2, 2025

Antidepressants or Lithium!



One of my ex-juniors, now retired, called to ask if I have read about another celebrity suicide. How very sad!


Link: The son-in-law of Prince and Princess Michael of Kent killed himself after suffering adverse side-effects from antidepressants!
He had initially been given sertraline - an anti-depressant - and a sleeping tablet, by a Royal Mews surgery GP.
Kingston complained this was not making him feel better and his doctor moved him off sertraline to citalopram, another selective serotonin re-uptake inhibitor (SSRI) used as an antidepressant.
Link:

8,000 coroners’ inquests of in England and Wales between 2003 and 2020 were analysed in which antidepressants were mentioned.
They found that drugs were linked to 2,718 cases of hanging and 2,329 overdoses, of which 933 people had overdosed on antidepressants.

Dr. Baldessarini of Harvard:

“Lithium is far from being an ideal medicine, but it’s the best agent we have for reducing the risk of suicide in bipolar disorder,” Dr. Baldessarini says, “and it is our best-established mood-stabilizing treatment.” If patients find they can’t tolerate lithium, the safest option is to reduce the dose as gradually as possible, to give the brain time to adjust. The approach could be lifesaving.

In recent write ups about antidepressants, there is no mention of Lithium. The Cockroach Catcher first worked with one Australian Psychiatrist that worked with Cade and I was, so to speak, very biased towards Lithium. Yes, Lithium has side effects that might be serious. But hang on, you get to live to experience it. Think about it.


"Many psychiatric residents have no or limited experience prescribing lithium, largely a reflection of the enormous focus on the newer drugs in educational programs supported by the pharmaceutical industry."

One might ask why there has been such a shift from Lithium.


Could it be the simplicity of the salt that is causing problems for the younger generation of psychiatrists brought up on various neuro-transmitters?
Could it be the fact that Lithium
 was discovered in Australia? Look at the time it took for Helicobacter pylori to be accepted.

Some felt it has to do with how little money is to be made from Lithium. After all it is less than one eighth the price of a preferred mood stabilizer that has a serious side effect: liver failure.

Some felt it has to do with how little money is to be made from Lithium. After all it is less than one eighth the price of a preferred mood stabilizer that has a serious side effect: liver failure.

Perhaps it is in the British History:
 Maudsley and Lithium
First, why a small group from the Maudsley Hospital in the 1960s could, in an almost malicious manner, have sown scholarly confusion about the true effectiveness of lithium. Aubrey Lewis, professor of psychiatry and head of the Maudsley, considered lithium treatment “dangerous nonsense” (). Lewis’s colleague at the Maudsley, Michael Shepherd, one of the pioneers of British psychopharmacology, agreed that lithium was a dubious choice. In his 1968 monograph, Clinical Psychopharmacology, Shepherd said that lithium was toxic in mania and that claims of efficacy for it in preventing depression rested on “dubious scientific methodology” (). Shepherd also scorned “prophylactic lithium” in an article with Barry Blackwell (). Moreover, Shepherd was publicly contemptuous of Schou. He told interviewer David Healy that Schou had put his own brother on it, and that Schou was such a “believer” in lithium that he seemed to think “really there ought to be a national policy in which everybody could get lithium”

 


Thank goodness: someone is talking about it.

 Atacama where Lithium is extracted  © Am Ang Zhang 2015

Lithium: The Gift That Keeps on Giving in Psychiatry

Nassir Ghaemi, MD, MPH
June 16, 2017

At the recent American Psychiatric Association annual meeting in San Diego, an update symposium was presented on the topic of "Lithium: Key Issues for Practice." In a session chaired by Dr David Osser, associate professor of psychiatry at Harvard Medical School, presenters reviewed various aspects of the utility of lithium in psychiatry.

Leonardo Tondo, MD, a prominent researcher on lithium and affective illness, who is on the faculty of McLean Hospital/Harvard Medical School and the University of Cagliari, Italy, reviewed studies on lithium's effects for suicide prevention. Ecological studies in this field have found an association between higher amounts of lithium in the drinking water and lower suicide rates.


These "high" amounts of lithium are equivalent to about 1 mg/d of elemental lithium or somewhat more. Conversely, other studies did not find such an association, but tended to look at areas where lithium levels are not high (ie, about 0.5 mg/d of elemental lithium or less). Nonetheless, because these studies are observational, causal relationships cannot be assumed. It is relevant, though, that lithium has been causally associated with lower suicide rates in randomized clinical trials of affective illness, compared with placebo, at standard doses (around 600-1200 mg/d of lithium carbonate).

Many shy away from Lithium not knowing that not prescribing it may actually lead to death by suicide. As such all worries about long term side effects become meaningless. 

Will the new generation of psychiatrists come round to Lithium again? How many 
talented individuals could have been saved by lithium?

APA Nassir Ghaemi, MD MPH
  • In psychiatry, our most effective drugs are the old drugs: ECT (1930s), lithium (1950s), MAOIs and TCAs (1950s and 1960s) and clozapine (1970s)
    • We haven’t developed a drug that’s more effective than any other drug since the 1970’s
    • All we have developed is safer drugs (less side effects), but not more effective
  • Dose lithium only once a day, at night
  • For patients with bipolar illness, you don’t need a reason to give lithium. You need a reason not to give lithium  (Originally by Dr. Frederick K. Goodwin)



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.

And many lives too!

I have just received a query from a reader of this blog about Lithium, and I thought it worth me reiterating my views here.      It is no secret that I am a traditionalist who believes that lithium is the drug of choice for Bipolar disorders.


Could Lithium be the Aspirin of Psychiatry? Only time will tell!

Tuesday, January 21, 2025

Rare Earth Element: Ecology!






Stringer Shanghai/Reuters - A man works at the site of a rare earth metals mine at Nancheng county, Jiangxi province on October 20, 2010.




One of the top non-medical posts:

“No, we are not getting the Prius anymore.”

“Why, isn’t it supposed to be green-er!”

“Not according to my daughter. She told me that it uses REE and is not as ECO friendly as we first thought.”

REE? Whatever is that, so I Googled it and found the USGS site:

The rare earth elements (REE) form the largest chemically coherent group in the periodic table. Though generally unfamiliar, the REE are essential for many hundreds of applications.

Chemical periodic table delineating the 16 rare earth elements (REE): the lanthanides, La through Lu, plus Y, whose geochemical behavior is virtually identical to that of the heavier lanthanides. Promethium has no long-lived isotopes and occurs naturally on Earth only in vanishingly small quantities. An represents the first 14 actinide elements; Lr is the last actinide.

Then from Channel 4:

Green campaigners love wind turbines, but the permanent magnets used to manufacture a three megawatt turbine use about two tonnes of 'rare earth'.

Wind turbines on the Silk Route © 2008 Am Ang Zhang

Champions of a low carbon future have yet to wake up to the environmental price Chinese workers and villagers are paying. At Copenhagen politicians talk of cutting carbon emissions, but they cannot meet any targets without 'rare earth' – that means a sustainable supply and not all from China.

Each Toyota Prius motor uses 1 kg of neodymium, and each battery 10- 11 kg of lanthanum, both 'rare earth' elements.

Compact fluorescent light bulbs use europium, terbium and yttrium. Without these, they don't work.

Hard discs, LEDs, I-phones and various military technologies also need rare earth minerals and metals.

The Independent: On the main Inner Mongolian city of Baotou-capital of REE.
Independent
The development of Baotou into the global capital of rare earths, 
which occupy their own obscure corner of the periodic table, is due to
two things: its proximity to the Baiyunebo mine, a vast open pit that is
the world's largest rare earth mine, and Beijing's deliberate policy of at
least two decades to turn this "Mother Lode" into a stepping stone 
towards status as an economic superpower.
As a result, Baotou has rapidly become of great interest to the outside
world. China, which by accident of geography holds about 50 per of the
world's rare earth deposits and currently produces 97 per of global
supplies, has made no secret of the nature or scale of its ambitions.