Lithium by Walter A. Brown

Author:Walter A. Brown
Language: eng
Format: epub
Publisher: Liveright
Published: 2019-06-02T16:00:00+00:00

6

Prophylaxis Rex

IN 1960, Schou got letters from Toby Hartigan, in England, and Poul Baastrup, a psychiatrist working in Glostrup, Denmark. The letters arrived at about the same time and were about the same thing. Since 1957, both men had been treating patients with lithium (Hartigan learned of lithium from Rice’s 1956 paper and Baastrup from a paper Schou had published in 1955). What prompted them to contact Schou was that they had found that lithium not only allayed the symptoms of mania, but could also prevent episodes of mania and, most importantly, could prevent episodes of depression as well. Schou was now recognized as the foremost lithium expert, and Hartigan and Baastrup wanted to know what he made of their observations, particularly lithium’s unexpected ability to stop recurrent depression.

Hartigan had given lithium to 20 patients: 9 had episodes of just mania, 4 had periods of both mania and depression, and 7 had repeated bouts of depression. As in previous research, most of the patients with either mania alone or episodes of both mania and depression showed remarkable improvement; with few exceptions, lithium dispelled their manic symptoms and as long as they continued to take it seemed to prevent further episodes. There was nothing new in this. What was new came from Hartigan’s decision to give lithium to patients with just recurrent depression. Hartigan was aware that the little research to date on lithium’s use in depression suggested that it did not improve depressive symptoms, so rather than give lithium to patients in the midst of a depression, which seemed unlikely to be fruitful, he decided to see if lithium would prevent further depressions. Accordingly, he treated the patients’ depressions with ECT, and when they had recovered, he started them on lithium. Hartigan treated 7 patients in this manner. They had suffered frequent attacks of severe depression, as many as three or four per year. With lithium treatment, 5 of these patients stopped having depressive episodes.

In 1959, Hartigan described his experiences with lithium, providing detailed accounts of several patients, in a paper he read to the Southeastern Branch of the Royal Medicopsychological Society. Hartigan’s paper was noteworthy on several counts. Much of the early research on lithium, and certainly later research, focused on relapse rates and other statistics. In the reports of these studies, as is invariably the case in the reports of contemporary treatment studies, the victims of manic-depressive illness are numbers placed in one category or another. Hartigan’s approach, like Cade’s, was to portray in some detail what happened to particular patients when they got lithium:

In relating my own experiences with the drug I have decided to describe in brief the case histories of certain individual patients. I have not concerned myself with the problem of proving or disproving the efficacy of the drug from a scientific standpoint as the numbers I have treated personally (only twenty) are insufficient for the purpose, and in any event . . . several large-scale trials, some even with acceptable controls, have already been carried out by others.

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