I have history with lithium. More history than most folks would care for.
But before we get into all of that, I would like to talk a bit about the history of lithium. It was first discovered/isolated in 1817 by the Swedish chemist Johan August Arfwedson.
Lithium was immediately put to a variety of industrial uses—though lithium ion batteries were many decades in the future—and “medicinal uses” including the treatment of “brain gout”—an early name for depression. It was first officially used for the treatment of bipolar disorder in the late 1930s and was approved by the FDA in 1970, but it had been used for the treatment of mania in manic depression since the 1870s.
Incredibly volatile, lithium occurs in nature, but never as a free element; almost always in some form of salt. The drug lithium is usually taken in the form of lithium carbonate. Lithium carbonate can be mined, but medical lithium it is usually evaporated from seawater. Lithium carbonate and other lithium salts also occur naturally in varying concentrations in groundwater. There are companies like Crazy Water based out of Mineral Wells, Texas that sell bottled water with naturally occurring lithium in it: Crazy Water.
This study shows a correlation between lower rates of violent crime and suicidality in cities like El Paso, TX that have higher concentrations of lithium in their drinking water: Lithium in drinking water and the incidences of crimes, suicides, and arrests related to drug addictions . A persistent legend says that bipolar disorder also has a low occurrence in El Paso, but I have not been able to find a study that investigates that particular claim. Nicknamed “Sun City”, El Paso boasts 302 sunny days a year, this might also have something to do with these lower numbers as well. Who knows for sure?
Lithium remains the gold standard for the treatment of bipolar disorder.
If one can tolerate it.
Lithium is a wonder drug in many ways, but with one major flaw: it has a very low therapeutic index. In other words, the effective dose of lithium is just under toxic levels. In fact, only about a third of bipolar patients can tolerate lithium’s side effects. This low therapeutic index is also why lithium levels must be closely monitored. And why when toxic levels are reached, lithium toxicity can be life threatening. As it was in my case.
Everyone knows that Coca-Cola once contained cocaine, but did y’all know that 7up contained lithium until 1948? When originally introduced in 1929 its name was the snappy"Bib-Label Lithiated Lemon-Lime Soda”. Just rolls off the tongue, don’t it? For some odd reason they quickly changed the name to 7up.
As you can see in the above advertisement, 7up was sold as kind of a patent medicine—a hangover cure and mood enhancer. While lithium is still used by psychiatrists to treat the drastic mood swings common to bipolar disorder (especially bipolar I), 7up’s days as a hangover cure (and diet drink) were relatively short-lived. Thankfully its time as a beverage marketed to infants is over as well.
A bit of trivia: the 7 in 7up may be a reference to lithium’s atomic number, which is 6.94, some times rounded up to 7. The “up” part of 7up is thought to be a reference to the mood lifting properties ascribed to lithium.
I first took lithium back in the mid-nineties. This was not long after my diagnosis changed from Major/Clinical Depression to Bipolar II Disorder, and then rather quickly to Bipolar I Disorder. When you are first prescribed lithium there is a titration period that can last several weeks or even months to find an effective, but not toxic dose. In the beginning you have many blood draws to check your lithium levels. If I recall correctly I was given a low initial dose and then my level was checked in one week, the dose was raised and then checked in a week. This goes on until the lithium level is in the therapeutic range generally 0.5 to 1.2 mmol/L (millimoles per Liter). Try to remember those numbers for later in this post.
I started to have a little nausea with lithium and found the regular blood tests for lithium levels hard to keep up with. I was without a car during this period, so I would have to borrow my dad’s car to get my bi-monthly tests, which was a real hassle for both of us. I was taken off of it after about two years. I think that I was prescribed Depakote (which has its own share of potentially nasty side effects) soon after, but memories of the early days of my mental health treatment are foggy at best. In the years before I had decent health insurance, a bewildering amount of psychiatrists prescribed me an even more bewildering variety of psychiatric meds. This includes more than a few meds that have since been found to be contraindicated for treating bipolar disorder—I’m looking at you Paxil, Prozac, and other SSRIs. I’m also looking at you gabapentin. Many times I wished that I had just learned to deal with the regular blood draws and the nausea that was a side effect of lithium, because at least it was an effective treatment.
And I had to deal with far worse side effects with future drugs—movement irregularities, nausea again, extreme fatigue, brain zaps, short and long term memory loss, ringing in the ears, increased suicidal ideation, sexual dysfunction, loss of feeling in the extremities, and massive weight gain leading to diabetes type 2.
No wonder I used to regularly stop taking my medications!
Mind you, these are just the worst side effects I can recall off of the top of my head. There were myriad lesser reactions that have escaped my Swiss cheese memory banks.
About four years ago my psychiatrist and I decide to try lithium again after I failed yet another bipolar drug regimen.
For years I had no major side effects.
Until I did—and brother did they ever make up for lost time.
I had confusion, decreased memory, diarrhea (TMI, I know), dry mouth, EKG changes including a drastically lowered heart rate, severe tremors, headache, hyperreflexia (overresponsive reflexes), elevated white blood cell count, weakness, muscle twitching, nausea, increased thirst, increased urination, vomiting, vertigo, acute kidney failure, low blood pressure, high body temperature, inability to walk, and more that I have since forgotten. The local poison control center was consulted for the first several days I was in the hospital. Lithium toxicity is a bitch. When I was first tested in the ER, my lithium level was 2.5—more than double what is considered the highest safe lithium level. You can see in this chart below all of the seventeen times in twelve days that my blood was drawn for my lithium level. At one point I was having draws every four hours—no wonder I was anemic when I left the hospital!
I will talk more about my hospitalization in the next installments, but thank you for joining me on this little foray into the history of lithium and my own history with the third lightest element.
Thank you, as always, for reading.
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