On lithium for 30 years – a patient talks
Prof. Raveen Hanwella’s MediScene column is back!
There are around 200,000 persons with bipolar affective disorder (BPD) in Sri Lanka. Some are undiagnosed and others are not taking medication. BPD is a serious psychiatric disorder characterised by severe fluctuations of mood resulting in social indiscretions, financial losses, high risk of suicide, and serious disruption of function and family life.
Lithium carbonate was first used for BPD by the Australian psychiatrist John Cade in 1959. Nearly 70 years later, it remains the most effective drug for BPD. However, because of unwarranted fears that it causes kidney failure and other dangerous side effects, even some psychiatrists are hesitant to use it. BPD once diagnosed, needs lifelong treatment, but with good management patients can lead a normal life.
Here I interview one of my first patients in a long career in psychiatry whom I started on lithium around 1990. He is still on lithium, has no major side effects and doing well in life. (He has granted me permission for publication. I have withheld personal details to prevent identification.)
When did you first develop the illness?
It was in 1984. I was overseas with a business colleague and bought an entire shop full of clothes, including 13 pairs of shoes. I had to pay a heavy customs duty and afterward did not know what to do with all the items I had bought. In the end, I sold it all to my friend.
Did you see a doctor at the time?
No, I did not know that it was an illness. Neither did my wife.
When did you first see a doctor?
It was in 1989. My business was in trouble and I became very depressed. And my brother brought me to see you.
What happened after that?
I was severely depressed to the point of thinking about suicide. I was so afraid that I once hid behind the piano. First you prescribed imipramine, but I did not recover. You then recommended shock therapy, but my family was hesitant because they were afraid of side effects. You also suggested admission, but my family was unwilling because I was well known in the community. In the end, you reluctantly agreed for me to be cared for at home and increased the imipramine. I was under constant surveillance because of the risk of suicide. Fortunately, I recovered with no after effects.
When did you recover?
It took about a month. It was then you started me on lithium. That was also the time you diagnosed me as having bipolar disorder.
What was life like after you started on lithium?
It really made a difference. My life became stable. I paid off all my debts, recruited new staff, and rebuilt my business into a stable company. During this period, my youngest child was born. Since then, I have never had a serious depression. I understand that people with this illness often have problems with drinking and smoking. I was never a smoker, and I gave up drinking in my teens. If not for that, I am sure I would have been in trouble with alcohol, especially as I have free access to liquor in the course of my business.
Have you had any problems at all with lithium?
No, I have had no side effects with lithium. I admit I did not do the tests you wanted regularly. I may have sometimes taken less than the amount of lithium prescribed, but I never stopped taking it.
Were there any relapses while on lithium?
I never had a serious depression after starting on lithium but I have had a few ‘highs’. My wife and family notice more than me. I get more irritable and sometime ago I had a situation when I was socially indiscreet. You then increased the dose of lithium. My wife and family were very understanding. I also had a serious financial loss a while back, but unlike before, I did not become seriously depressed. I have slowly rebuilt my finances and I am stable now.
Does anybody else in the family have similar problems?
Yes, two of my siblings and one of my children are on lithium. They are all doing well in their respective professions. I think all of us as a family do well on lithium. There are some other members of the family who have significant fluctuations in mood, but have never sought treatment.
Do you think the illness has helped you in any way?
You mean by making me more creative? No, I don’t think so. I am anyway a very creative person and always thinking of new ways to do things. In my profession, I have introduced many innovations to Sri Lanka.
Any closing words?
I would like to thank my wife and family and you, my doctor, and of course, lithium, for what I am today. If not for them, I would be dead. I hope this interview would help persons in Sri Lanka who have the same problem to understand their illness and seek treatment without fear.