The Discovery of Lithium – Part 4

Welcome to what is the final installment in our four part investigation into the history of lithium and it’s many uses. Parts 1, 2 and 3 can be accessed HERE , HERE and HERE for anyone late to the party.

Lithium has been applauded as the penicillin story of mental health. The first effective medication for a mental illness, it has also been labelled Australia’s greatest mental health story.

Australian scientist John Cade’s (1912 – 1980) rediscovery of the drug lithium, after it’s earlier use in the late 19th century, stands as a matchless accomplishment in the history of Australian psychiatry.

Yet a doctor is nothing without patients. Today we examine the incredible story of John Cade’s first ever human patient for lithium therapy, a man by the name of Bill Brand. It has been said no patient has been more important to the history of psychiatry than him. Hopefully by the end of reading this, you will understand why.

Bill Brand was a 51-year-old ex-World War 1 soldier who had been psychotic for 30 years. This was back in the time when post traumatic stress disorder from serving in war zones was referred to as ‘shellshock’.

When he first came in contact with psychiatrist John Cade, he had been an inmate at Bundoora Mental Hospital in Melbourne for five years. Official reports describe him as ‘restless, dirty, destructive, mischievous and interfering … the most troublesome patient in the ward’.

The picture on the left shows psychiatric patients roaming freely on the grounds of Bundoora Mental Hospital in Melbourne Australia in the 1940’s.

Bill’s existence was the quintessential life of the seriously mentally ill patient. He cut off the tips of two fingers while working as a labourer. He was disowned and alienated from his own family and had been left in the asylum. Concerned at his son’s extremities of mood and threats of violence, Bill Brand’s own father encouraged Bill’s wife Pearl to leave him. She eventually did in 1930, taking their adopted daughter with her.

In a depressive stupor for months on end, Bill would talk slowly, each syllable having to be almost prized from his mouth. In 1934, a shellshock specialist, Dr Clarence Godfrey, pronounced him as ‘very mental’. This represented a worsening diagnosis than his previous label as just ‘mental’. It was also noted he had a peculiarly shaped head and that in this mal-nourished head only two teeth remained.

At the asylum grounds he’d fossick around the rubbish bins, try to spend money he didn’t have and attempt to abscond. When it came time to select a patient to test the mood-stabilizing drug lithium on – after having first tested it on himself for three weeks – Bill Brand was an obvious choice for the asylum’s head psychiatrist Dr John Cade.

Brand’s response to treatment with liquid lithium was so dramatic and rapid that, within three months, the notorious patient was able to be discharged and returned to the community on indefinite leave. He walked out of the asylum perfectly sane. Nothing had been seen like it in mental health before.

He sought and found work while living back with his parents. His recovery was nothing short of miraculous and the most glowing endorsement for the transformative powers of lithium. Unfortunately, there was to be a tragic twist in events. In many ways it is the archetypal story of mental health. Bill Brand returned to his old job, and at some point decided he didn’t need to take his medication any more.

The first sign that something was seriously wrong again came in the form of a letter to psychiatrist John Cade. Bill’s parents wrote that he had been ‘excitable and argumentative after a trivial row’. The year was 1949. Bill Brand returned to his psychiatrist and confessed to ceasing his lithium. He had indeed become ill again with bipolar. He was re-admitted to the asylum as eye-poppingly manic as ever.

When Bill returned, psychiatrist John Cade pushed his lithium harder and harder in a desperate bid to get him back to a normal mental health state. In the late 1940s, the correct dosage wasn’t known. Because of this Brand became toxic with lithium and died in 1950.

John Cade confessed years later it was the greatest shock and disappointment of his life and made him uncertain about the future of lithium as a mental health treatment. But over the course of the next two decades, lithium’s cause was championed by other psychiatrists, and ultimately it was successful.

Seventy years after this roller-coaster history, the role lithium plays today in the treatment of bipolar disease varies depending on who you ask. Many physicians still regard lithium as the gold standard treatment for people with bipolar – especially those with more severe cases of the condition – and claim it continues to be the single most important treatment for mental health that has ever been discovered. Others have gone so far as to call lithium “dangerous nonsense”.

As with many other issues related to mental health, the real answer may lie somewhere between these extremes and is reflected in different practices around the world.

** Attribution** A sampling of the same dozen or so previously cited information sources were again consulted to compile this account.

PS. Your bonus read this week is – no other way to put it – pretty heavy, courtesy of THE SCIENTIST magazine. Click HERE if you’re up for the challenge.

The Discovery of Lithium – Part 3

The first chapter (HERE) of our investigation into lithium looked at the role Australian scientist John Cade played in establishing lithium salts as the gold standard of psychiatric care for bipolar disorder from the 1950’s onward.

Our second chapter (HERE) examined exactly what lithium is, where it comes from and it’s myriad of diverse uses.

Today’s look-see will explore the history of lithium within the world of psychiatric care and answer the question “Was Australian scientist John Cade really the first to bring lithium use for mental care to the masses?” Seriously.

Tracing the history of lithium therapy is a little bit like trying to pinpoint the man who ate the first oyster. Lithium has been in medical use—including psychiatric use—since at least as far back as ancient Greek and Roman times.

Back in this era, people suffering from melancholia or mania would be soaked in alkali-rich mineral springs to soothe their conditions. Many mineral springs contain lithium, among other elements, and some of them such as Mineral Wells in Texas, even today have age-old reputations as “crazy waters”.

To understand how lithium entered medicine in more recent times we have to go back to the mid-nineteenth century when it was introduced -mistakenly as we now know – for the treatment of gout (a type of arthritis). Back then a commonly subscribed to theory was that recurrent episodes of gout could lead to mania and melancholia – ‘brain gout’, if you will. Lithium was viewed as a treatment to heal these states as well.

In 1871, American military physician William Hammond reported using lithium bromide in the treatment of mania. But nothing further came from it. Around the same time, two Danish doctors, brothers Carl and Fritz Lang, began treating recurring depression with lithium. However because publication of their work was in Danish and German it restricted their audience and their approach fell into disuse.

Slowly however lithium began to be seen as a general ‘pick-me-up’ tonic. It was praised for its supposed magical healing powers and considered useful in helping to manage everything from hemorrhoids, paralysis and constipation to diabetes, eczema, gallstones and kidney trouble.

Lithium beer was brewed and marketed in U.S. Wisconsin. In 1929, in the weeks before the Wall Street stock market crash, the popular soft drink 7-Up was launched, boasting lithium as an ingredient. There was even a lithium version of Coca-cola. At this time lithium was not regarded as a drug, but as a health-promoting dietary supplement. In the 1940’s Americans didn’t need a prescription to get lithium; all they had to do was walk into a health food store and ask for it.

Even the science-fiction writer H.G.Wells (1866 – 1946) included lithium and it’s calming restorative powers in a short story he wrote called THE RECONCILIATION. Lithium water stirred with whisky was a gentleman’s balm to settle unsteady heads introduced when the two central characters, both scientists, have a heated disagreement.

Yet lithium failed to develop the foothold in the medical world afforded other substance remedies. It’s fair to say the overwhelmingly vast majority of other medications in psychiatry, indeed the whole of medicine, are discovered and promoted with hefty pharmaceutical company support.

A patent is taken out, and, if all goes well, millions of dollars are scooped up by investors. But not for plain old lithium; dug from the earth, no one owned the patent but mother nature; elements on the periodic table can’t be patented. It therefore meant that no pharmaceutical company contorted itself to promote and push lithium hard in the marketplace at this time.

By the time John Cade was performing his experiments on guinea pigs in the late 1940’s however, lithium as a treatment for serious depression and schizophrenia had fallen out of favour and been superseded by other types of psychiatric therapy treatment, including the barbaric-by-today’s- standards insulin coma therapy.

It is therefore entirely accurate to conclude the role Australian scientist John Cade played in bringing lithium to the forefront of psychiatric treatment for the mentally ill from the 1960’s onward was NOT DISCOVERING lithium but RE-DISCOVERING it.

Gradually, after dosages approached uniformity and careful monitoring became routine, lithium in various compounds was recognized as an acceptable treatment for those suffering manic depression, or what is now known as bi-polar disorder.

Lithium gluconate was approved in France in 1961, lithium carbonate in Britain in 1966, lithium acetate in Germany in 1967 and lithium glutamate in Italy in 1969. In 1970, after passing the strict controls and approvals process imposed by the FDA (Food & Drug Administration) the United States became the 50th country to admit lithium to the pharmaceutical marketplace.

** Attribution ** A total of eleven different information sources were consulted for the writing of this article, including the 2016 published book FINDING SANITY which I read cover to cover last year.

** Next week, in our final installment, we take a look at Australian scientist John Cade’s very first lithium patient. Bill Brand has been described as the ‘single most important patient in Australian psychiatric history‘. His story is indeed a fascinating one.