The Poisoned Chalice

At a recent mental health forum on ‘Depression in Rural Ireland’ held in Ennistymon, Co. Clare, Dr. Bhamjee, a psychiatrist, said that ‘there is growing scientific evidence that adding trace amounts of the drug lithium to a water supply can lower rates of depression and suicide. I’m not sure what research the psychiatrist was relying upon, because very up-to-date research goes quite contrary to the above quoted assertion. There is also Dr. Bhamjee’s unsubstantiated assumption that depression is a neuro-biological condition rather than an emotion that arises to draw attention to struggles within the individual who is distressed. Surely, the fact that the suicide rate increases by 25 per cent during times of international economic recessions points to and supports that depression is due to problems in living and not some theoretical chemical imbalance!

Lithium is nature’s lightest metal and was discovered in 1818. It was then alleged to dissolve uric acid and subsequently was used as a therapy that could dissolve kidney stones and break up the uric crystals that collect in the joints of people who suffered from gout. In the late 1800s and early 1900s, lithium became a popular ingredient in tonics and elixirs and was even added to beers and beverages – maybe one of the sources for Dr. Bhamjee’s suggestions! However, lithium was eventually found to have no uric-dissolving properties and in 1949 the FDA banned it after it was found to cause cardiovascular problems.

Curiously, in the same year it was banned in America, it appeared as a psychiatric drug in Australia. A physician, John Cade, observed that guinea pigs became docile following a dosage. Following this observation he decided to administer the drug to ten ‘manic’ patients and he deemed the outcome to be successful. However, in writing up his findings he omitted that the lithium treatment killed one person and made two others severely ill. Makers of lithium tonic have long known that lithium can be toxic even in fairly small doses – hence my alarm in response to the notion of putting traces of it in water. Both intellectual and motor function can become impaired, and if too high a dose is administered, a person may fall into a coma and die.

In 1969 lithium reappeared in the United States as a treatment, strangely enough approved by the FDA that had banned it only 20 years before, for what was seen as a newly discovered disease! – bipolar depression (mood swings) – up to that point manic-depression was seen as a unipolar condition. Amazingly, given what was known of the dangers of lithium, only a few placebo controlled trials of the drug were ever conducted. Indeed, in the 1980s several investigators raised serious concerns about lithium’s long-term effects. Both in the USA and the United Kingdom, lithium was found to lead to much more hospital admissions and, that in short, the drug was causing more problems than it was designed to cure. Other studies found that individuals labelled bipolar and who were treated with lithium and then stopped taking it ended up ‘worse than if they had never any drug treatment’ (quote from Joanna Moncrieff, UK psychiatrist). Other studies found that more than 50 per cent of lithium-treated individuals would quit taking the drug due to its dulling their minds and slowing their physical movements. The most damning evidence came from researchers in the University of Illinois who found that at the end of four and a half years, a staggering 41 per cent had ‘poor outcomes’, nearly one half had been rehospitalised and as a group were not ‘functioning’ any better than those not taking the drug.

All the indications are that lithium is ineffective and is associated with various forms of harm. It certainly seems paradoxical that a drug that is supposed to be therapeutic for depression can worsen the course of the person’s distress. Nonetheless, there is no doubt that psychiatrists ensure the safety of their clients in prescribing lithium; indeed, regular blood tests are carried out to ensure safety.  Any ceasing or reducing of any psychotropic medication needs to be closely supervised by a medical practitioner.

There is a deeper issue to be considered and that is whether or not bipolar depression is a neuro-biological disease or a symptom of human problems in living. There is also the issue of how has it come to pass that in 1955 there were 12,750 people hospitalised with bipolar illness and in 2011 there are some six million adults in the USA with this diagnosis?

All of the foregoing begs the question: is bipolar depression a real condition or a scientific delusion? By asking the question I am really aware that people are deeply distressed by symptoms such as ‘bizarre’ beliefs and feelings of deep depression and that those experiencing these symptoms require intervention. What is at issue is how bipolar depression (and, indeed, other unsubstantiated psychiatric conditions) are described, classified and treated. In his book, Doctoring the Mind, Richard Bentall expressed the view that “most psychiatric diagnoses are about as scientifically meaningful as star signs, a diagnostic system which is similarly employed to describe people and predict what will happen to them, and which enjoys a wide following despite compelling evidence that it is useless.”

The position is that psychiatry is an emperor without clothes and this situation has serious implications for government social policy that currently invests psychiatry with legal powers that threaten the wellbeing of very distressed individuals who come under their care, particularly, those who are involuntarily admitted to psychiatric units.

Dr. Tony Humphreys is a clinical psychologist, author, national and international speaker. His book with co-author Helen Ruddle, The Compassionate Intentions of Illness is relevant to this article.