StayOnTop: Depression

In 2009, Japanese researchers found that in places where the drinking water happened to contain natural levels of lithium, suicide rates were significantly lower. It prompted some psychiatrists to suggest we might help prevent suicides by adding a little bit of lithium to all drinking water. This sounds almost like an echo of the past: between 1930 and 1950, the American soft drink 7 Up contained lithium as a standard ingredient. This was done not for the mood effects, which were not yet really known at the time, but because lithium can also help against headaches. It was added to 7 Up specifically to make that drink a good hangover cure.

    Lithium is an element that in the form of lithium salt tablets works as a mood stabilizer: it narrows the bandwidth between your ups and your downs. It makes the ups (such as manic episodes in a bipolar depression pattern) less high, and it makes the downs (such as suicidal-feeling episodes) less deep. Following the Japanese findings, would lithium be a perfect anti-suicide medicine? I should know, because I have used it for several years in addition to other antidepressants, until half a year ago I decided to stop taking it. In that last half year, I certainly noticed my moods getting more extreme. More about that in a minute: some background first.

    Just like pigs (see here) played a role in the discovery of the therapeutic effects of electric shocks, little rodents played a role in the discovery of the therapeutic effects of lithium. In 1949, the Australian psychiatrist John Cade was researching possible causes of schizophrenia. One of the things he did was injecting rodents with urine extracts from his patients, in order to test if something in it might be related to schizophrenia. For control tests (to be able to compare) he also injected some of the animals with a “neutral” mix containing lithium urate. He soon noticed that this lithium had the effect of tranquilizing his rodents, and began to use it successfully to prevent extreme manic moods in psychiatric hospital patients.

    It took about 20 years, until 1970, before lithium was generally accepted as a mood-controlling drug. One reason for this slow acceptance was that the pharmaceutic industry was not keen on introducing a drug that, being a natural element, could not be patented and would therefore be less profitable. Another factor was that with lithium you always need to take care to find the optimal dose: a bit less may be much less effective, while a bit more can be dangerous. Too much lithium can permanently damage your kidneys or even be deathly. During the many years I took lithium, every few months the psychiatrists had my blood checked to make sure my lithium level was within the right margins.

    In my case, lithium was used as a mood stabilizer on top of varying other antidepressants (such as a tricyclic one, about that another time). And stabilize my mood it did. Last summer, after consulting my psychiatrist, I decided to try going on without lithium. After a while, the effects of this decision turned out to be more clear than I had expected. I became (and still am) much more labile. Apparently, my lithium intake had always suppressed this facet of my personality.

    One of the most striking differences was that I after I quit taking lithium, I found myself crying more often. My lithium tears – of course I should in fact say my no-lithium tears – are often simply sentimental tears. Innocent experiences like watching a touching movie or even just reading some human-interest news item can suddenly trigger such tears. I cannot remember the same thing ever happening when I was still using lithium. Another example of increased emotional lability is that I became much more irritable. Things like too-loud music from my neighbors can more easily throw me into a fit of almost uncontrollable rage now. I feel like I still have to learn (or re-learn) some ways of keeping my emotions under control.

    This intensifying of emotional reactions can be seen as regaining some normal part of life: as rediscovering several real-life colors that had been covered by a dull gray lithium blanket before. But it also means that normal feelings of unhappiness and even my periodically recurring suicidal moods, while not fundamentally changed, appear to be felt more intensely now. I know this is a potentially dangerous consequence: at times it might push me just one little step closer to the abyss.

    So concluding, I must say that for myself lithium may certainly have worked as an effective medication supplement. This leaves me with the question: would it in my own case be wise to start using lithium again? This is of course a matter of weighing the big pro against the big con. The big pro of lithium would be that it might help me just that little extra bit to keep suicidal feelings under control. On the other hand, the big con would be that it probably would make me emotionally less receptive again, and therefore might rob me of some of the more colorful and valuable aspects of life.

    When considering lithium, you should also be aware of its potential side effects: the ones listed most often are dehydration, dry mouth, gout, kidney problems, skin problems, thirst, and weight gain. These are potential side effects, meaning that not everyone using lithium will experience them in the same way, or even at all.

    Another thing to keep in mind is that to be effective, a daily dose of lithium needs to be kept within a very narrow bandwidth. Compared with other kinds of antidepressants, here this is extra important. A bit too little means it won’t work, while a bit too much may be harmful. This is why you should never use lithium without medical supervision: it is strongly advised to have your blood checked at regular intervals, to make sure that the lithium level in your blood remains within the proper limits.

    What matters most? What is most important, the pros or the cons? Because each of us is a unique person, you can decide only for yourself.

UPDATE: right now – a year after writing this post – I’ve chosen to do without any medication at all. After some months, I can say I’m doing fairly well. I am more capable of enjoying things, but on the other hand of course less stable emotionally. I’m willing to keep taking the risk for now.
    Let me stress, however, that weighing these pros and cons may be a very different, very individual matter for each of us. If you decide to stop using lithium, the best way to avoid disaster is making sure that a psychiatrist keeps monitoring you at regular intervals.

• tip: For lithium you pay with less vivid emotions; for other medicines you might have to pay in other ways, for example with less alert reactions when driving a car.
    Keep remembering that every medication that gives you something, may also take something away.

 
Author: Henk van Setten