The Relative Ineffectiveness of Lithium in Acute Mania

The myth of lithium specificity is shattered in exactly that arena in which one would expect to find the most support clinical use as described by its advocates. Early on, it became generally accepted that the neuroleptics, not lithium, are most effective in stopping acute mania (Baldessa-rini, 1978 Juhl et al., 1977). Even with the development of combined neuroleptic-lithium therapy, some authorities advocate ECT, as well, for the control of especially severe cases (Hollister, 1976). 

The clinical preference for the neuroleptics as the treatment for acute mania was based on the single most comprehensive, controlled study, which was conducted by Prien et al. (1972). They specifically contradicted the thesis that lithium has any specificity for mania or the underlying manic process. They cautioned that unfortunately, these observations have been all but lost in the vast number of unqualified endorsements of lithium carbonate therapy that have deluged the literature. Alexander et al. (1979) and Growe et al. (1979) also opined that lithium is not disease-specific for mania. 

In the past, a great deal was written about the use of lithium for the control of violence (Fieve, 1989 Marini et al., 1977 Micer et al., 1974 Morrison et al., 1973 Sheard et al., 1976, reviewed in Breggin, 1983b). While these claims have not been confirmed, they focus once again on the tendency to use or advocate lithium for a variety of purposes. 

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