In a major stride in direction of bolstering strategic assets, Prime Minister Narendra Modi’s current go to to the United States final month culminated within the launching of a collaborative initiative targeted on recovering and processing essential minerals, notably lithium. This partnership underscores the rising significance of lithium in numerous sectors, from energy storage to prescription drugs. Lithium, denoted by the image Li, has atomic quantity 3 and is a silvery-white alkali metallic. It was found in 1817 when Swedish chemist Johan August recognized it inside the mineral petalite. In 1821, William Brande efficiently remoted lithium in its elemental kind by way of the electrolysis of lithium oxide.
Due to persevering with exploration, measured and indicated lithium assets have elevated considerably worldwide, totalling about 105 million tons as per the U.S. geological survey in 2024. Major lithium reserves are concentrated in South America’s ‘Lithium Triangle’—encompassing components of Bolivia, Argentina, and Chile. Australia is the main producer, extracting lithium from hard-rock spodumene deposits. India’s lithium deposits are in Reasi (Jammu & Kashmir) and Mandya (Karnataka), with exploration ongoing in Rajasthan, Chhattisgarh, Jharkhand, and Himachal Pradesh. The current Indo-U.S. initiative goals to get better and course of lithium.
Lithium’s journey in medication
In 1859, Alfred Baring Garrod printed a paper in The London and Edinburgh Monthly Journal of Medical Science analyzing lithium’s potential to dissolve uric acid crystals, proposing its use for gout remedy. The speculation stemmed from chemical observations relatively than medical trials. While lithium salts confirmed promise in vitro, therapeutic purposes had been restricted by toxicity and impractical dosing. The research marked one of many earliest discussions on lithium’s physiological results, however its medical relevance remained unsure.
In 1949, Australian psychiatrist John Cade printed a seminal paper within the Medical Journal of Australia detailing his discovery of lithium’s antimanic properties. Cade hypothesised that mania was linked to a metabolic imbalance and carried out experiments, injecting guinea pigs with urine from manic sufferers, observing poisonous results. He administered numerous compounds to establish the toxic substance, noting that lithium carbonate has a relaxing affect on the animals with out sedation. Translating these findings to medical apply, Cade handled ten sufferers with mania utilizing lithium salts, reporting vital temper stabilisation and discount in manic signs. This groundbreaking research launched lithium as an efficient remedy for temper problems like acute mania and bipolar dysfunction.
Melbourne’s Noack and Trautner (1951) and French psychiatrists Despinoy and De Romeuf (1951) independently examined lithium in manic sufferers, reporting effectiveness. Despite preliminary scepticism and considerations over toxicity, additional research, notably by Danish psychiatrist Mogens Schou within the Fifties and 60s, confirmed lithium’s efficacy as a temper stabiliser. By 1970, lithium was authorized for the remedy of bipolar dysfunction within the United States.
Mechanism of motion and ongoing mysteries
Lithium’s precise mechanism in stabilising temper problems isn’t totally understood. It is hypothesised that it influences neurotransmitter exercise and intracellular signalling pathways, by competing with sodium ions due to their chemical similarities as alkali metals. This competitors might alter neuronal excitability and neurotransmission. Despite its lengthy historical past of use, the exact organic underpinnings of lithium’s mood-stabilising results proceed to be a analysis topic. Lithium has a slim therapeutic window (0.6–1.2 mEq/L), requiring common monitoring to stop toxicity. It is absorbed orally, distributed evenly in complete physiquewater, and is excreted unchanged through kidneys, necessitating renal perform monitoring. It isn’t utilized in pregnant ladies.
With lithium, the distinction between an efficient dose and a poisonous dose is small. At therapeutic ranges, lithium stabilises temper, however even slight elevations can lead to toxicity, inflicting neurological, renal, and cardiac problems. Lithium additionally interferes with thyroid perform, main to hypothyroidism. Over time, this will lead to fatigue, weight achieve, and depressive signs, additional complicating bipolar dysfunction administration. Lithium exemplifies the Paracelsus’ precept—”the dose makes the poison”—whereby a slight deviation from the therapeutic vary can flip it from a life-saving temper stabiliser right into a poisonous agent. It additionally has a delayed onset of motion—usually requiring weeks to present full results—which signifies that extra rapid-acting medicines are often most well-liked in acute manic episodes.
Second-generation antipsychotics have emerged as viable alternate options to lithium due to their mechanism of motion and higher security profile. Unlike lithium, which acts because the supply of bipolar dysfunction by inhibiting sodium-GPCR protein pumps in neurons, SGAs act at a downstream stage by modulating neurotransmitter exercise, significantly dopamine and serotonin. This distinction signifies that whereas lithium exerts its results on the root of the dysfunction by stabilising neuronal exercise, SGAs regulate the signs extra instantly by blocking extreme neurotransmitter motion.
Indications for Lithium Use
Despite the growing use of SGAs, lithium stays the drug of selection for particular bipolar dysfunction displays, maniac episodes and suicidal tendency prevention. It is handiest for traditional euphoric mania and bipolar dysfunction with a robust genetic element. Lithium uniquely reduces the chance of suicide in bipolar sufferers, a profit that SGAs don’t replicate. Its mood-stabilising properties are significantly precious in stopping relapses, making certain long-term remission, and managing treatment-resistant circumstances.
What prompted John Cade to hypothesise lithium for temper stabilisation stays a larger thriller than the unknowns surrounding its mechanism of motion. His work was printed in 1949 when the connection between medical analysis and ethics basically differed from at this time’s requirements. Cade’s experiments instantly after WW-2 mirrored an period the place scientific curiosity usually operated in a vacuum, impartial of moral issues. With the institution of recent analysis ethics, together with knowledgeable consent, medical trial rules, and oversight committees, such an experiment—wouldn’t even be doable at this time. Yet, these historic inquiries remind us that medical developments have usually emerged from unconventional and ethically questionable explorations.
In addition to its position in psychiatry, lithium is indispensable in battery know-how, nuclear energy, ceramics, and lubricants.It performs a vital half in carbon neutrality by enabling renewable energy storage.
(Dr. C. Aravinda is a tutorial and public well being doctor. The views expressed are private. aravindaaiimsjr10@hotmail.com)
Published – March 17, 2025 05:41 pm IST
