Clinical Controversies and Theoretical Mode of Action of Lithium Carbonate

Abstract

Cade’s (1) discovery in 1949 of lithium’s therapeutic success in mania has precipitated two decades of continuing investigations, clinical trials and controversial findings. With few exceptions numerous investigators have confirmed Cade's original observations concerning lithium’s effectiveness in combating mania. Under double-blind conditions, 4 of these studies (2, 3, 4, 5) have shown lithium to be superior to placebo in reducing manic symptoms. Apart from these 4 double-blind studies, an estimated 6,000 patients in many countries have been given lithium by a variety of research teams numbering near 400. A review of these open studies to date reveals that on the average 80 % of all manic patients treated have responded quickly and satisfactorily to lithium carbonate. Of note is the fact that this success in mania was independent of age, sex or duration of the manic disorder.