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Monday, 12.04.2021

Janusz Rybakowski: Lithium The Amazing Drug in Psychiatry 


Janusz Rybakowski’s reply to Samuel Gershon’s comments


        Many thanks to Sam Gershon for his positive comment on my book (Rybakowski 2020). I am proud that Sam had been my compatriot, albeit shortly, and I have always had great esteem for him as a key person of the Australian lithium story and also as the icon of American psychopharmacology.

        The book describes my adventure with lithium which was the main motive of my half-century psychiatric career. In the book I endeavored to place lithium both in the historical and contemporary context. For historical background, mainly the Australian account, I greatly took advantage of Sam’s contribution to the ongoing discussion on lithium in the framework of INHN. I am happy that these efforts were assessed by Sam as pretty successful.

        However, I cannot prevent a feeling of unfulfillment as to lithium use worldwide which was also echoed by the main specialists in the field. Two years ago, I wrote a paper titled “Challenging the negative perception of lithium and optimizing its long-term administration,” in which I indicated the advantage of lithium over other mood-stabilizing drugs and possibilities of effective management of lithium side-effects (Rybakowski 2018). In the same year, an American expert on bipolar disorder, Robert Post, deplored the fact that lithium is greatly underutilized in the USA, even more than in Europe. He pointed to the multiple assets of lithium and argued that the fear of lithium’s adverse effects can be exaggerated (Post 2018).

        It should be pointed out that in 1999, Sam Gershon became the first Editor-in-chief of the journal Bipolar Disorder, now ranked among the top 20 psychiatric journals. Recently, Gin Malhi, the journal’s current Chief Editor, also calls for a better utilization of lithium’s therapeutic potential and more frequent use of the drug in an editorial titled “Make lithium great again” (Malhi, Bell, Boyce et al. 2020).

        To popularize lithium on the American soil, I was to chair a session titled “The advancing quality of psychiatric care with broader lithium use” during this year’s APA in Philadelphia. The other speakers of the session included Michael Bauer from Dresden, Germany, the current president of the IGSLI (International Group for the Study of Lithium-treated Patients), Bob Post and Michael Gitlin from LA. Philadelphia is a “stomping ground” for me, as it is where I did lithium work in collaboration with Jay Amsterdam, Alan Frazer and William “Dutch” Dyson.

        Unfortunately, due to the pandemic, the meeting did not materialize. However, I have submitted a presentation for next year’s APA meeting in LA, and changed the title to “Finding mood equity through broader lithium use,” hoping that it will be accepted.

        Sam also suggests using the book for educational purposes. Unfortunately, the printed version of the book was very limited allowing me only to send it to my closest lithium-oriented friends. However, the e-book is available at



Malhi GS, Bell E, Boyce P, Hazel P, Murray G, Basset D, Bryant RA, Hopwood M, Lyndon B, Mulder R, Porter RJ, Singh A, Gershon S. Make lithium great again! Bipolar Disord, 2020;22:325-7.

Post RM.  The new news about lithium: an underutilized treatment in the United States. Neuropsychopharmacology, 2018;43:1174-79.

Rybakowski JK. Challenging the negative perception of lithium and optimizing its long-term administration. Front Mol Neurosci, 2018;11:349. 

Rybakowski JK. Lithium – the Amazing Drug in Psychiatry. Termedia Wydawnictwa Medyczne, Poznań, 2020. E-book:


February 18, 2021