Wednesday, 13.12.2017

Reply by Samuel Gershon

LITHIUM CONTROVERSY

Samuel Gershon’s reply to Martin M. Katz’s comment

I thank Marty for his thoughtful comments on this issue and can only agree that in this case it was only the initial clinical observations that presented even the possibility of pursuing studies with lithium. There was no prior scientific basis for conducting the initial clinical studies and there was much evidence that it could produce serious and even lethal outcomes. The earliest controlled studies in acute mania could show its efficacy and this alone could be taken seriously. The major point with these studies was that with lithium we had a NON-Sedative compound producing behavioural and psychological control of acute mania. Also, subsequent controlled studies showed that in the manic form of schizo-affective disorder, lithium could not do this, and the usual outcome was an increase in clinical symptoms with EEG changes showing disturbances of the EEG. So, at this point, we had a possibility of therapeutic specificity.
          Also, as Katz points out, the issue of long term therapeutic effect and prophylaxis, this was a more difficult task to confirm. However, as he stresses, with long term treatment and follow up of manic-depressive patients  clinicians could observe  such positive effects.  Recent studies by Grof et al (2014) supported earlier reports by others, namely, that a group of  “typical” bipolar 1 patients could be maintained  well and episodes prevented  and that the euthymic phase in these patients was a restitution to normal clinical baseline and  normal functionality. This latter point should be stressed, that is, they could return to their former functions in their former jobs.  Thus 65 years after Cade’s report, we can and should conclude that we have with lithium, the only specifically effective compound in manic-depressive disorder and mood stabilizer.

Samuel Gershon

March 26, 2015