Barry Blackwell: Lithium Controversy

Samuel Gershon’s reply to Janusz Rybakowski’s comment

I appreciate Dr. Rybakovski’s careful documentation of some of the issues in this debate. One old issue was that lithium was not effective for the treatment of Bipolar disorders. Well, this was partly right, as not all cases labelled Bipolar in many studies were NOT bipolar, they were schizoaffective or schizophrenic, or etc. In our NYU controlled studies, we showed that this latter group did not do well with lithium…they did poorly, but did much better with chlorpromazine or Haldol.  In our uncontrolled Australian studies, we attempted to characterize a classic or typical BP mania and these episodes had a very high, about 80% good response rate.  In our own follow up studies at NYU, we also experienced very good responders prophylactically and they had a classic feature, a very good euthymic phase, i.e., restitutio ad integrum. This one feature has also been mentioned by Grof, Alda and Rybakowski, Thus with our diagnostic systems over time and with DSM V, all cases in a study pool are not alike and results will continue to vary somewhat until we actually get a good biomarker. Thus we have discovered a very good treatment if we know what we are treating.

Samuel Gershon

September 17, 2015