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BMJ 1998; 316 doi: (Published 02 May 1998) Cite this as: BMJ 1998;316:1330

Still effective despite its detractors

  1. James W Jefferson, Clinical professor of psychiatry
  1. University of Wisconsin Medical School, Middleton WI 53562

    In 1812 Benjamin Rush observed that “Many mad people, who have attempted to destroy themselves by cutting their throats … have been cured by the profuse haemorrhages.” Blood letting soon became his first remedy for mania.1 With the advent of a more scientific approach to medicine, this treatment, based on centuries of tradition and glowing clinical testimonials, fell into well deserved disrepute. Should lithium follow it?

    Almost 140 years after Rush's observations John Cade noted that the toxicity of urine injected into guinea pigs was attenuated by lithium. After finding that lithium had “no discernable ill effects” when he took it himself, Cade successfully treated 10 manic patients with the drug.2 Thus, in 1949, the modern era of lithium therapy began. Almost simultaneously, however, the ill advised use of lithium chloride as a salt substitute for patients on low sodium diets produced reports of neurotoxicity and death.3 From this beginning the battle lines were drawn. Was this simple element a safe and effective cure for various ills or an ineffective but toxic nostrum?

    In …

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