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Comment by mnemonicsloth | Hacker News Reader

> Even so, treatment breakthroughs have lagged and the drug often prescribed for the condition, lithium, was first used nearly 75 years ago.

This is false. I don’t know what this author was doing. Even reading Wikipedia would give you a better understanding than that.

Initial treatment for patients presenting with acute mania are antipsychotics like Risperdal or Geodon. After that they might try mood stabilizers like lamotrigine or seroquel, or any number of other things that are much more recent than lithium.

If you want to learn more about the wild world of psychopharmaceuticals, I recommend crazymeds.com, which also tells you a lot about how mentally ill people often view themselves. It’s fascinating even if you’re not crazy.

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My experience has been that Lithium is still very widely prescribed for bi-polar disorder as well as BPD (borderline personality disorder).

It's not that there aren't alternatives, but they are much more hit-or-miss in terms of efficacy. Lithium tends to be more predictable in terms of keeping things stable, but the side effects are awful.

* http://www.crazy-meds.org/

Lithium is still the fallback drug of choice with the best track record. In some countries it's as much as 50% of patients.

I was first put on lamotrogine and it's mental side effects were far more debilitating than lithium's physical side effects. Lamotrogine destroyed my working memory to the point I'd consistently leave food on the stove and just forget about it. Lithium also works better for me. It is also dirt cheap compared to alternatives which don't work as well for many people.

Other forms of Lithium also have potential for future treatments, with Lithium Orotate being considered for trials recently (few side effects, safer, crosses blood brain barrier more effectively, but was mischaracterized in the 70s and largely ignored until now).

A friend of mine was bipolar and died of lithium toxicity. Bipolar is a challenging disease to treat, and the treatments don't work for everyone. We can't get better treatments and ways to figure out which treatment will work for a given patient soon enough.

I was also on lamotrogine for a period of time and the cognitive decline was real. Not only was memory affect I also suffered from severe brain fog. Years later I still feel as if I haven't recovered completely from it.

Lithium works great but it's not a good long term solution as years of use is terrible for the kidneys.

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