Janusz Rybakowski: Lithium The Amazing Drug in Psychiatry 


Janusz Rybakowski’s reply to Hector Warnes’ comment


        Many thanks to Hector Warnes for his positive comment on my book (Rybakowski 2020). In the context of the adventure with lithium as the main motive of my half-century psychiatric career, I was trying to describe both the historical and contemporary aspects of this amazing ion. I am happy that the one as well as the other were assessed by Hector as successful.

        On a historical note, I concur with Hector with his great appraisal for the clinical acumen of a great 19th-century Danish scientist, Carl Lange, in describing the symptoms of depression. His description remained valid into 21st century. Carl Lange can be definitely regarded as a precursor of using lithium carbonate for the treatment and prophylaxis of periodic depression and such knowledge is obligatory for psychiatrists. However, Carl Lange is also reputable for psychologists as a co-founder of the first physiological concept of emotions, known as the James-Lange theory. This was an aftermath of his work published in 1885, in Danish (Lange 1885) and 10 years later in French (Lange 1895). Lange had also great achievements in neurology and his enormous contribution to science should be remembered and propagated.

        Similar to Hector, I have a great appreciation for the concept of "excellent lithium responders" as a significant milestone of lithium prophylaxis. It was introduced in 1999 on the 50th anniversary of introducing lithium into contemporary psychiatry, by eminent Canadian psychiatrist of Czech origin, Pavel (Paul) Grof (Grof 1999). The input of Paul to the lithium story is manifold. For instance, together with Mogens Schou and Bruno Müller-Oerlinghausen Paul was in 1989 a founding father of the IGSLI (International Group for Study of Lithium-treated Patients). Paul is now in Ottawa and serves as an active member of INHN. It should be mentioned that Paul's brother, Stanislav (Stan) Grof, has been one of the founders of the field of transpersonal psychology and a researcher into the use of non-ordinary states of consciousness for purposes of exploring, healing and obtaining growth and insights into the human psyche.

        In 2018, the book Ota Pavel – pod powierzchnią (Ota Pavel - under the surface) appeared in Poland, as a biography of prominent Czech writer, Ota Pavel, or Otto Popper (1930-1973) (Kaczorowski 2018). In the early 1950s, Pavel had a nervous breakdown (most probably depression) during military service. In 1964, when working as a correspondent during the Olympic Games in Innsbruck, a psychotic manic episode overtook him. He was hospitalized in Prague and later in other psychiatric hospitals, receiving pharmacotherapy and electroconvulsive therapy without much improvement. As reported in the book, "In 1967, Doctor Pavel Grof, a young psychiatrist from the psychiatric clinic located in Bohnice district of Prague, proposed him a treatment with lithium which resulted in spectacular improvement. Ota Pavel reported it in a letter to his brother Hugo: ‘One day a miracle appeared. A MIRACLE. My doctor came with a wonderful powder. After this, he was shaking my hand and released me from the clinic.’" In subsequent years, Pavel took lithium and wrote his best works, among others “Smrt krásnŷch srnců” (The death of beautiful roe-deer). According to his son, a significant adverse effect of lithium was polydipsia resulting in drinking a great amount of fluids and significant weight gain (Kaczorowski 2018).

        Just recently, a paper appeared making the supposition that one of the biggest 20th century tyrant leaders, Stalin, took lithium. This finding was obtained by analyzing the books read by Stalin at the turn of 1930/40s, using extremely sensitive EVA (ethylene-vinyl-acetate) spectroscopy. Such therapy would have been top-secret and no account of it is available. In 1927, the famous Soviet neuropsychiatrist, Vladimir Bekhterev, upon a long examination of Stalin’s mental status suggested that the leader might be affected by paranoia. The next day, Bekhterev was poisoned by the agents of the secret police OGPU. At this time they did not use novichok, however, the poison was effective, resulting in the death of the scientist within one day (Zilberstein, Zilberstein and Righetti 2020).  

        Thus, the issue of lithium is still alive both from the historical and contemporary point of view. I am very glad that Hector makes himself an active witness for this fascinating story.



Grof P. Excellent lithium responders: people whose lives have been changed by lithium prophylaxis. In: Birch NJ, Gallicchio VS, Becker RW, editors. Lithium: 50 Years of Psychopharmacology, New Perspectives in Biomedical and Clinical Research. Weidner Publishing Group, Cheshire, Connecticut, 1999, pp. 36-51.

Kaczorowski A. Ota Pavel – pod powierzchnią. Wydawnictwo Czarne, Wołowiec, 2018.

Lange CG. Om Sindsbevægelser. Et Psyko-Fysiologisk Studie. Lund, Copenhagen, 1885.

Lange CG. Les émotions. Ėtude psychophysiologique. Alcan, Paris, 1895.

Rybakowski JK. Lithium – the Amazing Drug in Psychiatry. Termedia Wydawnictwa Medyczne, Poznań, 2020. E-book: www.termedia.pl/eBook/-231.

Zilberstein G, Zilberstein S, Righetti PG. Stalin's "black dog": a postmortem diagnosis. Anal Bioanal Chem, 2020;412(28):7701-08.


March 4, 2021