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Lamictal or trileptal more sedating

THIS ARTICLE, and the companion article on antipsychotics, is meant to be read with the other articles in this series.

He then tried the agent on human subjects, with eye-popping results.

There the story might have ended, but for the efforts of Danish psychiatrist Mogens Schou, who demonstrated lithium's efficacy as a preventive agent (including for those with recurrent depression) in a number of studies conducted over the 1950s and 60s.

This set the scene for regulatory approval in Europe and the US in the early 1970s.

The success of lithium - along with the introduction of antidepressants and antipsychotics at about the same time - opened up a new era of biological psychiatry.

Early lithium studies reported success rates of up to 80 percent for the treatment of mania, but more recent results show lithium to be effective in about 40 to 50 percent of subjects.

There are a number of theories for this drop-off, but the most credible one comes from Frederick Goodwin MD, former head of the NIMH and co-author of ."The illness has been altered," he told a session at the 2008 American Psychiatric Association annual meeting.(I was in the audience, but I'm using Robert Whitaker's account, here.) He went on to say: Today we have a lot more rapid cycling than we described in the first edition [which came out in 1990], a lot more mixed states than we described in the first edition, a lot more lithium resistance, and a lot more lithium treatment failure than there was in the first edition.The illness is not what Kraepelin described anymore, and the biggest factor, I think, is that most patients who have the illness get an antidepressant before they ever get exposed to a mood stabilizer.At an APA session six years earlier, Dr Goodwin chastised the psychiatric profession for opting for the newer mood stabilizers promoted by the drug companies.(No drug company owns the rights to lithium.) A major problem, he said, is doctors who can't be bothered with the careful blood monitoring lithium requires, owing to its high toxicity.(The med can be potentially damaging to the kidneys, where it is metabolized, and also the thyroid).Dr Goodwin's beef was not over whether doctors preferred to use another mood stabilizer first, but that so many chose not to use lithium at all, especially younger practitioners.The patients Dr Goodwin sees tend to be those referred to him by other doctors, who have presumably tried their patient on everything and failed - except, to Dr Goodwin's utter dismay - lithium, by far the most researched bipolar med.Lithium has demonstrated efficacy across all phases of treatment, including acute and maintenance mania, and acute and maintenance depression, though its effect appears to be weaker on the depressive end.This qualifies lithium as the only true "mood stabilizer," though the term is loosely applied to the other bipolar meds.

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