Janusz Rybakowski: Lithium The Amazing Drug in Psychiatry 


Hector Warnes’ comment on exchange after Barry Blackwell’s response to Janusz Rybakowski’s reply to his comment on his monograph



       I am overwhelmed with ideas which unfortunately cannot be turned into "mental experiments."

       Many years ago, I read a paper about a town in the USA which had higher levels of lithium in the drinking water. The authors linked this finding to a lower prevalence in the population of dysfunctional behavior and better adaptation in the community.

       Belmaker and Rybakowski considered lithium to be an essential trace element. Lithium in drinking water was linked with a lower suicide rate. Blackwell in an illuminating sentence writes: "It is a disservice to science, medicine and psychiatry to suggest that alleged sloppy diagnosis or overprescribing becomes an excuse for limiting the use of a highly specific and effective remedy for a disabling disorder." We are all aware that our "alleged" diagnostic categories continue to be a truism, sloppy and plagued with overprescribing.

       It would be a step forward to carry out systematic studies in order to confirm the experiment that adding a micro-dose of lithium in the drinking water (e.g., 300 mcg per day) could have anti-aging, anti-violence and anti-suicidal effects. I am wondering why in the water we drink no trace of lithium can be found using biochemical measures unless there is lithium in the soil. The only oligoelements found in blood are zinc, iron, copper, sulfur, selenium, chromium, cobalt, iodine, manganese, fluoride and molybdenum. Each of these oligoelements (from the periodic table) have specificity and are necessary for different organismal function particularly, iron, copper, cobalt and iodine. 

       Unfortunately, only one third of bipolars are excellent lithium responders providing that the "the therapeutic window" and the permanent use of the drug is maintained just like a hypertensive or insulin-dependent patient. The degree of patients’ compliance has not been optimal in most of medicine. The biological marker or the precise genetic polymorphism that would facilitate our search for excellent lithium responders has not been found either.

       Ernst Kretschmer’s typology (leptosome-asthenic, athletic, pyknic and dysplastic) has shown that each of these types are prone to a cluster of illnesses. The pyknic usually found in the person who is overweight would be more prone to depression and may be obese, have insulin resistance, hypertension and the metabolic syndrome. Should other genes be inherited the patient may have hyperuricemia (gout). Uric acid is a metabolic product of adenosine, a purine nucleoside. The purinergic system comprises signalling pathways involving the neurotransmitter adenosine triphosphate (ATP) and the neuromodulator adenosine. The system is responsible for neurotransmission, synapse formation and neuronal plasticity.

       Purinergic signalling dysfunction may alter other neurotransmitter systems and cause neuroinflammatory changes. Kretschmer found a higher prevalence of the pyknic type in the circular or bipolar disorder. Inhibition of inositol monophosphatase may be crucial in the action of the metal ion lithium. Inositol phosphate-phosphatase are enzymes of the phosphodiesterase super-family which include phosphodiesterase V widely used in male erectile sexual disorders.


August 19, 2021