Lithium: A Doctor, a Drug, and a Breakthrough

by Walter Brown

The remarkable untold story of a miracle drug, the forgotten pioneer who discovered it, and the fight to bring lithium to the masses. The DNA double helix, penicillin, the X-ray, insulin―these are routinely cited as some of the most important medical discoveries of the twentieth century. And yet, the 1949 discovery of lithium as a cure for bipolar disorder is perhaps one of the most important―yet largely unsung―breakthroughs of the modern era. In Lithium , Walter Brown, a practicing psychiatrist and professor at Brown, reveals two unlikely success that of John Cade, the physician whose discovery would come to save an untold number of lives and launch a pharmacological revolution, and that of a miraculous metal rescued from decades of stigmatization.

From insulin comas and lobotomy to incarceration to exile, Brown chronicles the troubling history of the diagnosis and (often ineffective) treatment of bipolar disorder through the centuries, before the publication of a groundbreaking research paper in 1949. Cade’s “Lithium Salts in the Treatment of Psychotic Excitement” described, for the first time, lithium’s astonishing efficacy at both treating and preventing the recurrence of manic-depressive episodes, and would eventually transform the lives of patients, pharmaceutical researchers, and practicing physicians worldwide. And yet, as Brown shows, it would be decades before lithium would overcome widespread stigmatization as a dangerous substance, and the resistance from the pharmaceutical industry, which had little incentive to promote a naturally occurring drug that could not be patented.

With a vivid portrait of the story’s unlikely hero, John Cade, Brown also describes a devoted naturalist who, unlike many modern medical researchers, did not benefit from prestigious research training or big funding sources (Cade’s “laboratory” was the unused pantry of an isolated mental hospital). As Brown shows, however, these humble conditions were the secret to his historic Cade was free to follow his own restless curiosity, rather than answer to an external funding source. As Lithium makes tragically clear, medical research―at least in America―has transformed in such a way that serendipitous discoveries like Cade’s are unlikely to occur ever again.

Recently described by the New York Times as the “Cinderella” of psychiatric drugs, lithium has saved countless of lives and billions of dollars in healthcare costs. In this revelatory biography of a drug and the man who fought for its discovery, Brown crafts a captivating picture of modern medical history―revealing just how close we came to passing over this extraordinary cure.

Genres: Nonfiction, Science, History, Medicine, Psychology, Mental Health, Audiobook

256 pages, Hardcover

Published August 13, 2019

Reviews

[Morgan Blackledge · Rating 5 out of 5]

This is an important book.

It could save lives.

Just as the title suggests.

This is Walter A. Brown’s history of the discovery and the oddly difficult promotion of lithium as a mainstream treatment for the symptoms of bipolar disorders.

With good treatment, bipolar symptoms are absolutely manageable.

The main barriers for people getting good treatment are misinformation and stigma.

The gold standard medication for bipolar conditions is lithium.

That’s right.

Lithium.

Contrary to folk wisdom (or lack there of).

For a large group of people suffering from bipolar symptoms.

Lithium can be a FANTASTIC treatment.

But again.

Lithium is also HIGHLY stigmatized.

For no good reason at all.

This book clarifies where all that stigma originates from.

It does a great job of normalizing both bipolar symptoms and lithium treatment.

I dearly hope this information gets out there.

This book is a terrific resource for both professionals and the general public.

GREAT BOOK

5 ⭐️‘s

[Peter Tillman]

Nature's mixed review: https://www.nature.com/articles/d4158...
Excerpt:
"The drug that set off the ‘psychopharmacological revolution’ of the 1950s, with antipsychotics and antidepressants arriving in its wake, is in many ways a stunning success. Yet it was developed in a ramshackle pantry, and the bottled urine samples were stored in [John Cade, an Australian psychiatrist] family refrigerator. Moreover, in retrospect, the discovery of lithium seems in part related to an erroneous interpretation on Cade’s part. The ‘tranquillized’ guinea pigs were probably showing the first symptoms of lithium poisoning: lethargy is still a warning sign of an overdose. And the step from guinea pigs to humans was a “conceptual leap”, as Brown kindly puts it — hardly a deduction from sound theory. It is unlikely that a modern researcher would get permission for experiments such as Cade’s."
So, probably not for me. But an interesting bit of history, ingenuity and creative improvisation.

[Karen MacLaurin]

Excellent review of the history of lithium use in the treatment of manic depression and the contribution of John Cade and other psychiatrists who refined his research. A must read for anyone suffering from manic depression or who knows anyone taking lithium for this reason.

My grandmother was part of an experimental group in Sudbury, Ontario in the mid to late 1960s who benefitted from lithium and the regular blood tests to check on levels in her system. She was elderly by the time she was introduced to the drug. She had previously been given shock treatments in Montreal in the 1950's which left her "addled" as she said. To the end she did not truly understand her condition. However, lithium made her life and all of our lives more manageable. I highly recommend this book.

[Constance · Rating 4 out of 5]

Excellent information if one is interested in medication, mental health, and research which I am.
It took me a month to to finish this book because I was looking up words, highlighting, and re reading parts that made an impact.

Mental health is not to me taken lightly. It is debilitating, it devastates families, and the one suffering from any form of mental illness is overwhelmed. Until you get the right combination of drugs, your life seems hopeless.

We as a nation need to put mental health in the forefront. We cannot afford to sweep it out the door.
Be compassionate if you know someone who struggles on a daily basis to feel "normal"

[Tori · Rating 4 out of 5]

** I received an advanced reading copy from a Goodreads giveaway

An overall excellent book. Very detailed and truly gives us the big picture about the significance of lithium. The story of John Cade is an interesting one, he was truly a good man in more ways than one. From a POW to the first advocate for lithium, John Cade has transformed the lives of those around him no matter what the circumstance.

My only gripe for the book is that it could be about 20-40 pages shorter as many information is repeated and at points it was way too repetitive.

[Erica · Rating 3 out of 5]

This was a difficult book to finish, however I felt the need to finish it after the first two chapter, hoping that it would get better. As others have mentioned in their reviews, there is a lot of repeated information. This could have almost been a short story, rather than a book. There was little information given about the actual drug, as there is still a lot of unknowns. There were also a lot of tangents in the story, that made the book feel like it was going on forever.

[Aubrie · Rating 3 out of 5]

Repetitive in many places, but I learned some things. I think that this book could have gone even further into the history and symptoms of mania itself. Overall I think that there still isn't enough info about Lithium - we still don't know how it helps those with bipolar disorders - and perhaps this book was written too soon because of that. But it was an easy read anyway.

[Katie · Rating 3 out of 5]

3.5 stars
The information contained in this book was riveting, but the writing style didn’t hold my attention. The author often repeated a fact several paragraphs after first stating it. It felt like an attempt to meet a publisher’s page requirement. I learned a great deal and made notes to do further research on the topic, but with a good editor this could have been cleaned up a bit.

[Khan Ashraf Alif · Rating 5 out of 5]

Nicely done 👍

[Jovany Agathe · Rating 5 out of 5]

One of the most mysterious drugs of all is lithium, a ridiculously simple, geologically abundant monoatomic ion that is the gold standard for bipolar depression treatment. Walter Brown's book tells the fascinating story of how Australian doctor John Cade discovered it.

[Csimplot Simplot · Rating 5 out of 5]

Excellent book!!!!!

[Piotr Krawczyk · Rating 4 out of 5]

Książka ta to chyba pierwsza na świecie i tak szeroko promowana (amazon) "biografia" litu - jednego z leków charakterystycznych wyłącznie dla psychiatrii, a którego wprowadzenie zdecydowanie zmieniło leczenie zaburzeń nastroju. Jest to przede wszystkim opowieść o naukowcach, którzy od 1948 roku lit badali i mieli odwagę wdrażać go do leczenie u swoich pacjentów. Znajdziemy tu także nieco anegdot sprzed "ery litu", czyli z okresu XIX i początku XX wieku, ale dominującą część stanowi dość skrupulatny opis badań prowadzonych przez Johna Cade'a i Mogens'a Schou oraz innych psychiatrów z połowy XX wieku, dzięki którym dziś lit jest używany w medycynie.
Jest to żywa opowieść, którą czyta się szybko i przyjemnie, ale, co zrozumiałe, nie jest to opowieść dla każdego - medyczne zastosowanie węglanu litu brzmi bardziej jak temat doktoratu, niż ciekawej książki. Wszystkim, którzy interesują się historią medycyny, a szczególnie psychiatrii i farmakologii bardzo polecam.

[Traci · Rating 4 out of 5]

My Mom is bipolar and has taken lithium since 1972. I have never known her as anything but a loving, invested mother. PTA, Vacation Bible School, Girl Scouts, she did it all. Before the lithium they tried electric shock therapy. Something my Dad went to his grave feeling guilty about. I believe lithium saved not Mom's life alone but that of our family. We were not perfect, Mom and Dad divorced in the mid 80's after 19 years of marriage. Mom is 75 now and has been living with cancer for the last five. We don't what the future holds but my sister and I will help Mom face it together.
This book helped put into perspective what Mom was going through when she was first diagnosed. Lithium was new to the US market at the time and I will be forever grateful to the doctor who first prescribed it to her. Thanks to that doctor my sister and I had as close to a "normal" mother and childhood as anyone could hope for in this crazy world. Note: I listened to this as an audiobook.

[S · Rating 3 out of 5]

Well researched but somehow both repetitive (wait, didn’t I read this already?) and filled with extraneous information (what’s this got to do with lithium/Cade?)
I can see author’s passion for and knowledge of the topic but he fails to pull you in to the excitement.
Despite being less than 200 pages, a bit of a drag to read. Probably could’ve been half the length and still have all the necessarily information.

[Tim · Rating 2 out of 5]

Feels often more like historiography and the editing is poor. Paragraphs repeat and punctuation is annoying.

[Clark · Rating 5 out of 5]

Fascinating anecdotes; this book shed light not just on the history of this drug, but on the history of psychopharmacology at large. I was fascinated by the depiction of "artist scientists" and by how much of lithium's failures and successes had more to do with politics than with the drug. A couple interesting stories:

One of the people who was trying to get lithium off the ground was working closely with a scientist who was a nobody in the industry. This scientist was providing excellent, reliable counsel, but the first guy had to write to the nobody and say "PLEASE publish something, I'm begging you. You're right about everything you're telling me and my lab can verify all your results but I can't keep saying that I'm getting this information from some unpublished rando, people are gonna quit taking me seriously."

Another fun story: in the early days of lithium, there was a big controversy because the people who ran experiments "proving" that lithium was safe and effective, even prophylactic, had refused to do placebo controlled double blind studies. This was because lithium had already been observed anecdotally to work SO well that the scientists designing these studies felt it would be unethical to withhold it from patients who could benefit from it, as in the case of a placebo controlled study.

Good writing, neat stuff. Rounding up from 4.5.

[Irene · Rating 4 out of 5]

Quite interesting book. It starts with the disease and how it was conceptualized, and then moves onto how Lithium was started to be investigated. This is the best part of the book, as you can see how research and experimental methods were progressing till arrival to double-blind experiments, setting up the standards for medical science. You can also see the effects of not following this standards and the mistakes they made scientist arrive at. Really fascinating stuff, and useful for me as a scientist and teacher of research methods.
The books ends with an overview of how the use of Lithium extended to other countries, and particularly UK and USA. And finally, with an overview of ideas and end of life of the Australian scientist who proved the use of Lithium to cure several different mental disorders. It ends a little like it started, with a bit more personal kind of perspective, on the scientist himself, as it is common apparently nowadays to narrative through a more personal experience. Not my favorite thing, to be honest, hence that I think the intermediate chapters are really the core of the book, and again, really fascinating. Still, I highly recommend this book.

[Beth Ann Ditkoff · Rating 4 out of 5]

This book was a well-written and organized account of the history of the discovery of lithium. An obscure Australian psychiatrist, John Cade, performed the first experiments, documenting that this drug had efficacy in the treatment of patients suffering from bipolar illness (previously called manic-depressive illness). Although the book had some interesting tidbits about the history of this element--it was once use as a salt substitute for people on low sodium restricted diets until it was discovered that the lithium was reaching toxic doses causing disability and death--the majority of this book goes in chronologic order to discuss additional scientists' contributions to elucidating the safety profile of lithium. I thought that there wasn't enough interesting material to make a full-length book, and some of the text was repetitive. I think this information would have been better suited to a lengthy magazine article. However, I found the book to be informative and educational.

[Bekah · Rating 4 out of 5]

A fascinating look at the history of lithium as a medical treatment for bipolar (previously known as manic-depressive illness). The book offers a short history on manic-depression along with the terrible "treatments" that were imposed on patients. We are then taken on the path of lithium's multiple starts as a medicine and the controversy of general public use, before finally gaining the attention of the wider psychiatric world. Despite not being patent-able and therefore of little interest to the pharmaceutical industry, to this day lithium is the best option for most bipolar people because it can reduce and *prevent* episodes. Lithium is even being looked at for its ability to reduce suicide.

While there is a bit of repetition throughout the book, I encourage anyone interested in the topic or curious about the history of lithium or bipolar to give this lay-person-friendly book a read.

[Rob Campbell · Rating 5 out of 5]

This is a great honor to the "renegade side of science." The book is load full of heroic researchers scattered around the globe, with little funding, and often unaware of each other's work. Unlike other meds, the researchers of lithium are not driven by rigorous dispassion.

The pharmaceutical industry does not come out looking good in this story. Because it is easily obtained, there is little incentive to invest in clinical trials and development that won't provide a good ROI.

Lithium provides the reader with an insightful look at the challenges facing the development of effective medications for the treatment of mental illness.

[Roger · Rating 3 out of 5]

I picked up this book because I had known clients from my own (social work) practice who had been successfully treated with Lithium. I learned that an Australian psychiatrist John Cade first wrote about using Lithium with bipolar clients in the late 1940’s. Only later did he learn of its value in preventing bipolar disease. Although less used now than in the 1960’s and 1970’s, it is still used. Newer psychiatric drugs promoted by drug companies now dominate the market. Lithium never had a drug company sponsor since it is a natural element and is thus not patentable or profitable to market. The book is mostly a history of the drug and its slow acceptance by medical providers.

[Kristina · Rating 3 out of 5]

Interesting book about the history of lithium and its use for bipolar disorder. Working the mental health field, I’ve observed the positive effects this drug has had on people. I knew that it wasn’t prescribed as much as it probably should, considering its high success rate. A lot is related to the lack of money making associated with it (its an element, unlike these pharma-produces drugs so money incentive for companies). Also talks about the scientists involved with the discovery and the long time it took for lithium to catch on.

[Chien-Wei Kung · Rating 4 out of 5]

An enjoyable chronicle of Lithium and those behind its discovery of use for bipolar disorder. Walter Brown does a great job giving us a picture of who John Cade was, and the remarkable life experiences he went through, and how his inquisitive mind in a humble lab allowed him to discover the remarkable effects of Lithium. Brown also gives us a bit of info on Mogens Schou and his role in Lithium's acceptance.
There were some places where it was slightly repetitive of details, but not enough to be distracting. Overall, really enjoyed it!

[Mrs. Palmer · Rating 2 out of 5]

This could have been so much more interesting, but it was just...not engaging. It was super repetitive too and the way it was written was confusing. It kept jumping back and forth in time and it really didn't seem to get at anything deeper than continuing to repeat the results of various studies and then going into depth on mostly irrelevant or uninteresting facts about the people who did the studies. Disappointing.

[Inflatigirl]

I should have loved this book, but I couldn't make it through the first chapter for one reason: 39 years after DSM-III changed the name to Bipolar Disorder, this author prefers to use the term "Manic-Depressive Disease" despite throughly explaining why the name was changed (mostly stigma). He also advocates for the term "depression" to be reverted to "melancholia" because depression is too "nonspecific" and "lack[s] magisterial presence".

[Nina · Rating 4 out of 5]

I like reading about science history, including medical science and about the history of mental illness, so this was right up my alley. I appreciated that it was a fairly quick read with an attempt to be objective about research feuds. I felt sad for some guinea pigs, but overall this was pretty interesting.

[Jessica · Rating 4 out of 5]

A well researched book about the re discovery of Lithium used to treat manic-depressive conditions. This book gives credit to the scientists who have made this possible and is very well written with charm and some funny commentary on the scandals. One thing is that the author repeats himself in subsequent chapters to help the reader not get bogged down by the information in the previous chapter. It’s a stylistic approach and it’s up to the reader if this frustrates you or not. However, this book is written in lamens and can be read by anyone!

[Caredwen Foley · Rating 2 out of 5]

At its best points, this book is a litany of trivia about lithium and about the people involved in research on its effects as a psychiatric drug. It would have benefited considerably from more aggressive editing — it is poorly organized, repetitive, and prone to tangents. I certainly learned some things about lithium’s history as a medicine, but I would not say I enjoyed the experience.

[Daniel Hardy · Rating 4 out of 5]

I will say I didn't give this book my full attention (audiobook) so take this with a grain of salt. What I did pay attention to j generally enjoyed. I definitely learned, but as others have said the book was pretty repetitive - I wondered repetitively if my chapters were skipping and I was listening to the same thing he had just discussed.

[Anthony · Rating 4 out of 5]

A look at the 1949 discovery of lithium as a cure for bipolar disorder by John Cade, an obscure psychiatrist from Australia, working in isolation with little equipment and no research funds discovers the most important treatment discoveries in all of medicine.