Metal Marvel That Has Mended Brains for 50 Years - oldest drug in psychiatry

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Lithium—a simple metal and the oldest drug in psychiatry—might protect the brain against mental illness, Alzheimer’s, and other diseases. One problem: There’s no profit in it.

Lithium is as puzzling as it is potent. It was the first drug used to treat mental illness, and more than 50 years later, it is still one of the most widely used psychiatric medications. But the doctors who prescribe lithium to their patients still do not know how it works or even why it works. “It is the most mysterious drug in psychiatry,” says De-Maw Chuang, a biologist at the National Institute of Mental Health. “It’s so small, but it is so powerful.”

Unlike other psychoactive chemicals—large, complex molecules like Prozac (fluoxetine) or Abilify (aripiprazole)—lithium is extremely simple. It is an element, the lightest of the metals, and its chemical properties are similar to those of the sodium in table salt. Nonetheless, researchers have recently found that lithium could be something close to a psychiatric wonder drug. It has two remarkable powers in the brains of mentally ill patients: protecting neurons from damage and death and alleviating existing damage by spurring new nerve cell growth. Far beyond its current application as a mood stabilizer, lithium could be helpful in treating or preventing Alzheimer’s disease, schizophrenia, stroke, glaucoma, Lou Gehrig’s disease (amyotrophic lateral sclerosis), and Huntington’s disease—an impressive tally that earned it the nickname “the aspirin of the brain” in the journal Nature.

In the United States, lithium is now the first-line treatment for bipolar disorder, a dangerous condition with the highest suicide rate of any psychiatric illness. Lithium compounds, usually given as lithium carbonate or lithium citrate, have three beneficial effects on bipolar patients: preventing mania, easing acute manic episodes, and, to a lesser extent, lifting depression.
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