Author: Thiago Lopes Genaro
Have you ever eaten an oyster? With lemon? Gratin? Were you afraid of food poisoning? Who first looked at this shell divided into two parts and decided to open it? I’m going to tell you a behind-the-scenes story about science.
In the 1970s, at an FDA meeting, Gerald Klerman, at the time a professor of psychiatry at Harvard University’s medical school, advocated the use of lithium in episodes of mania, in bipolar disorder. He was then questioned by the FDA team about the lack of studies in the scientific literature at the time proving the effectiveness of lithium. They would have said of Professor Klerman: “he is like the man who ate the first oyster.”
I looked for this expression “who ate the first oyster”. I discovered a book about this subject: Who Ate the First Oyster? The Extraordinary People Behind the Greatest Firsts in History. Who first wore pants? Who first rode a horse? Who first used gold as jewelry? Who would have eaten the first oyster? Who first used lithium to treat emotional symptoms?
Dr Klerman was not the first to use lithium in medicine. In the 19th century, this substance was used to treat gout (a disease related to uric acid, with the deposit of crystals in the joints). There is a report of the use of lithium to treat emotional symptoms in 1871, by a doctor named William Hammond. A century later, lithium was being defended at an FDA meeting. A courageous and cutting-edge defense based on years of research.
Lithium now appears in all treatment guidelines for bipolar disorder and is approved by the FDA for mania. It is present in the Canadian Guideline (2018), the Australian (2020), the Indian (2017), and the World Federation of Biological Psychiatry Societies (2017).
The scientific evidence for the use of lithium is great and so is the fear of using the medication:
– Doctor, will I use an element from the periodic table? What about my thyroid? And my kidney?
I often discuss with patients the beneficial effects and possible side effects of lithium. Medication safety tested over decades. Take care with periodic blood tests to identify potential problems early. A frank and courageous conversation.
“What life wants from us is courage.” This expression is present in a book called Grande Sertão: Veredas. The author is Brazilian Guimarães Rosa. The excerpt goes like this:
“The flow of life wraps everything up, life is like this: it heats up and cools down, tightens and then loosens, calms down and then becomes restless. What life wants from us is courage”.
Bipolar patients need courage on their journey. Courage to understand the diagnosis. Courage to face episodes of polarizing mood. Courage to trust the therapeutic regimens proposed by the doctor.Courage to open your own oyster. Courage for the extraordinary in life.