History of lithium

Although as an element lithium had been discov-ered in the 1800s and used in the fields of rheu-matology and psychiatry since this time, it was not until 1949 that the first academic work on lithium in psychiatry appeared. This work showed that lithium had a significant effect in a case series of 10 patients with mania presenting with ‘psy-chotic excitement ’ [Garrod, 1859; Lange, 1886; Cade, 1949; Schioldann, 2011]. By 1950 a hospi-tal-based trial had led to the development of indi-cators for safe lithium doses and initial signs of toxicity, including gastric disturbances, muscular weakness, ataxia and slurred speech [Ashburner, 1950; Noack and Trautner, 1951; Malhi and Gershon, 2009]. However, by 1951 lithium’s use in medicine had been somewhat discredited by reports of deaths in the USA and Australia after the widespread use of lithium salts as a table salt substitute [Corcoran and Taylor, 1949]. Despite being somewhat discredited by the early 1970s, lithium was first registered by the US Food and Drug Administration (FDA) for long-term prophylactic use in bipolar disorder with approval in the UK occurring by 1985 [FDA, 2012]. Lithium has since been licensed in the UK for the treatment and prophylaxis of mania and hypomania, prophylactic treatment of recurrent affective disorders, treatment of recurrent bipolar depression when the use of alternative antidepres-sants has been ineffective, and the treatment of aggressive or self-mutilating behaviour [Norgin