Dr. Lader has addressed some key issues that apply to all psychiatric diagnoses and treatments. The diagnostic profiles could move all the way from an elaborate Freudian unearthing of symptoms and underlying factors to the current massive studies by Pharma for one of their compounds for bipolar disorder and/or schizophrenia. This latter situation is fairly typical of many “anti-psychotic drugs”. It seems almost that every drug marketed for schizophrenia usually finds an honored place in treating both phases of Bipolar disorder. Also DSM 5, the result of much deliberation by many experts has not solved any of these problems. The situation with lithium includes many of these problems, however there are some separations. Although still open to Dr. Lader’s concerns is that in some of our controlled studies lithium was not beneficial to schizophrenic patients and would develop neurotoxic effects with EEG dysrhythmia. Thus with 65 years of work on lithium since Cade we all have to agree with Malcolm we still have many unanswered questions.   

Samuel Gershon
June 25, 2015