The History of Lithium in Medicine and Psychiatry

Abstract

This chapter outlines the main turning points in the history of the use of lithium in mental disorders. It is a history that begins in the eighteenth century with the study of gout, a condition that was endemic at that time. Gout was associated with melancholia, and its cause was widely attributed to an excess of uric acid. Thus when Garrod erroneously concluded in 1859 that lithium carbonate could dissolve uric acid in vivo, he became the first to specify the role of uric acid in affective disorders and to advise the medicinal use of lithium as a remedy. Hence, in the second half of the nineteenth century, in alignment with this hypothesis, Carl and Fritz Lange were the first to implement lithium therapy in patients to prevent depression. Consequently, they are regarded as the founding fathers of lithium therapy. However, the use of lithium was relatively short lived, and, at the turn of the century, lithium therapy for affective disorders was dismissed as nonsense by Christiansen (among others) and was almost completely forgotten for half a century. This is all the more remarkable given the scarcity of alternatives.

In 1949, John Cade, whose work aimed to identify the toxic factors of psychosis, discovered by chance what he believed to be a sedative effect of lithium and experimented with its use on manic patients. This treatment, though effective, led to the death of a patient, which prompted Cade to abandon lithium therapy. However, other psychiatrists began using it, and in 1954 Mogens Schou eventually confirmed the therapeutic effect of lithium. Nowadays, lithium is considered to be the most (and probably only) effective mood stabilizer, and it is one of many examples of how prolific the middle of the twentieth century was in terms of new treatments for mental disorders.