573. LITHIUM: FROM CADE TO THE MODERN DAY

Abstract Background In 2024, the 75th anniversary of introducing lithium into modern psychiatry was observed, attested by the article of Melbourne psychiatrist, John Cade, in the Medical Journal of Australia in 1949. Nowadays, lithium remains one of the most important psychotropic drugs, making it the gold standard for the relapse prevention of bipolar disorder. Aims & Objectives The presentation aims to discuss the story of lithium since Cade’s article in 1949. Method A narrative review will be applied. Results John Cade can be recognized as the pioneer of modern lithium therapy. After the experiments on guinea pigs and his lithium intake, he described the therapeutic effect of lithium in ten manic patients. Other Melbourne researchers, Charles Noack and Edward Trautner confirmed and extended this effect on more patients in 1951. A Polish emigrant, Samuel Gershon, working during this time in Melbourne, was instrumental in introducing lithium in the USA in subsequent years. The history of lithium then moved to Denmark, thanks to Mogens Schou, the biggest lithium researcher of the second part of the 20th century. Schou confirmed the anti-manic effect of lithium using a placebo-controlled trial in 1954. After showing lithium prophylactic effect in mood disorders by Geoffrey Hartigan in 1963 and Poul Christian Baastrup in 1964, Schou was the main researcher to demonstrate this effect on a great number of patients and organized the international trials of this issue. For lithium research, in 1975, Cade and Schou received the International Scientific Kitty Foundation Award. The important events in the lithium story were the establishment of the International Group for Study of Lithium-treated Patients (IGSLI) in 1989, by Mogens Schou, Paul Grof, and Bruno Müller-Oerlinghausen, and the starting the journal “Lithium” which was functioning in 1990-1994. The IGSLI investigators demonstrated in the 1990s the antisuicidal effect of long-term lithium treatment. Also, since the 1980s, the augmenting effect of lithium on the efficacy of antidepressants has been demonstrated. In the 21st century, the prophylactic effect of lithium in bipolar disorder, its antimanic action as well as anti-suicidal activity have been confirmed in many meta-analyses. Also, the neuroprotective effect of the drug as well as a prophylactic against and some therapeutic action in dementia disorders was observed. Recently, lithium reduction of all-cause mortality and morbidity of many somatic conditions (e. g. osteoporosis) was described. Discussion & Conclusions Lithium is the drug of the first choice for relapse prevention in bipolar disorder, according to all guidelines. Among mood stabilizers, lithium has the longest record of prophylactic treatment and the cases of half of century lithium therapy were recently reported. Long-term lithium therapy is connected with possible adverse effects, of which kidney injury is the most significant: these side effects can be successfully managed. There are also many beneficial outcomes of lithium therapy of which anti-suicidal and anti-dementia may be most important. However, despite the benefits, in recent years, there has been a trend of underutilizing lithium in behalf of other mood stabilizers, mainly atypical antipsychotics.