Barry Blackwell’s final reply to Janusz Rybakowski’s final comment

Barry Blackwell: The Lithium Controversy A Historical Autopsy.
Collated by Olaf Fjetland

       Once again, I am grateful to Janusz Rybakowski for sharing his encyclopedic knowledge of lithium usage over a half century perspective. What emerges is the uncontestable conclusion that lithium remains the best first choice for mood stabilization in bipolar disorders and still shows evidence of benefits for other novel indications.

       What concerns me at this moment in history is that despite being the least expensive and safest option it is not the most widely used, perhaps due to a number of factors including relentless, often misleading advertising of expensive non generic alternatives and an appearance of declining skill in management of plasma monitoring.

       Just over two years ago, JAMA published a survey of adverse events in emergency rooms showing that 16.4% of 10,000 visits were due to lithium toxicity of which more than half (53.6%) were hospitalized. The author’s interpretation was that this was due to excessive use of the drug and over treatment of bipolar disorders. No evidence was given concerning adequacy of preventative measures, including plasma monitoring, patient education or compliance. No effort was made to contact or educate the prescribing physicians; presumably many were primary care doctors.

       I wrote a letter to the Editor stating: “It is a disservice to science, medicine and psychiatry to suggest that sloppy diagnosis or prescribing of a highly specific and effective remedy like lithium for a disabling disorder should become an excuse for limiting its appropriate use.”

       I received a rejection from a group of sub-editors informing me my letter “did not receive a high enough priority rating for publication.”  I was invited to “contact the author of the article although we cannot guarantee a response.”


Blackwell B. Risk and Relevance of Lithium Usage on in Perspectives; 06/25/2015.


December 14, 2017