John Cade (1912–1980), Morgens Schou (1918–2005)
As the old spiritual song aptly tells us, “I’m sometimes up and I’m sometimes down.” Fluctuations in mood are a very normal pattern in life, but it’s not considered normal when the ups are too high and the downs are too low. Disorders of mood—so-called “affective disorders”—can be incapacitating to the patient and family members. Luckily, mood stabilizers such as lithium can bring relief.
Several decades after its discovery and isolation as a metal, lithium was used in the 1840s for the treatment of bladder stones and gout, and during the last three decades of the nineteenth century, it was used to treat mood disorders. Lithium chloride reappeared in the 1940s as a substitute for table salt (sodium chloride), when salt-free diets were shown to be beneficial in the management of patients with heart disease and high blood pressure. This seemed reasonable, since lithium resembles sodium chemically, pharmacologically, and in taste. In practice, however, it was responsible for kidney toxicity and a number of deaths in 1949. All lithium-containing products were withdrawn from the market.
That same year, after the Australian psychiatrist John Cade observed that injections of lithium urate caused guinea pigs to become sedated rather than excited. He observed that lithium carbonate calmed ten manic patients but was without effect in schizophrenics. During the 1950s and 1960s, the Danish psychiatrist Morgens Schou, following up on Cade’s results, conducted large-scale clinical studies demonstrating lithium’s effectiveness in preventing mania. Concerned about the toxicity of lithium, the Food and Drug Administration delayed approval of it in the United States until 1970, years after it was marketed in Europe. Lithium is now used to treat episodes of mania and to prevent reoccurrences of the wild mood swings seen in bipolar (manic-depressive) disorders.
Lithium is an unusual drug for the treatment of mental disorders, because, unlike related drugs such as Haldol, it has no effects on behavior in (behaviorally) normal individuals. It merely normalizes extreme mood and permits the manic patient to “come down” without feeling drugged or tranquilized.
SEE ALSO Haldol (1958).
The exact nature of Vincent van Gogh’s medical conditions remains a subject of active inquiry. His feverish outpouring of art during his final years suggest that he suffered from mania or bipolar disorder (manic-depression), a mood disorder now commonly treated with the use of lithium and other mood stabilizers. This self-portrait was painted in 1888.