Whether you learned about it in school or from the movies, schizophrenia is known about in pop culture for its wild symptoms. As a schizophrenic, being able to conjure up a person so vividly that they think they are seeing a real person that they can have a conversation with was bound to end up in a movie executives lap at some point. Having hallucinations such as these are part of the “positive” symptoms, or things that have been added on to normal everyday, schizophrenic life. There are also negative symptoms, which are a lack of doing something, such as depression or a lack of facial emotivity. Both of these kinds of symptoms have been hallmarks of the disorder for well over a century, and so treatment has also been experimented on for about as long.
Lithium (yes, the element, in pill form) has been used as a treatment for schizophrenia since at least the late 19th century. It didn’t become a scientifically-based treatment until 1949, and then took another 20 years to get approval from the FDA. The fact that it wasn’t scientifically recognized didn’t stop it from being an effective treatment well before 1949 though, and amazingly, it is still used to this day as one of the most effective treatments for schizophrenia.
This speaks to one of two things. We as a society have either lagged behind in research and development and haven’t been able to adequately come up with, discover, or create a better treatment than lithium, or we luckily discovered one of the best treatments possible for schizophrenia patients early on (way before a lot of medicinal updates) and so to this day it still works as an adequate treatment option that works well. The truth is closer to the second one, of course we’ve come up with more treatment options; we’ve been able to create synthetic antipsychotics that certainly do their job, all thanks to modern medicine. Lithium however, has stood the test of time, continuing to be one of the most effective, responsive treatments for schizophrenia.
Wnt signalling, a pathway for gene transcription among other things, is influenced by lithium. Lithium works to inhibit GSK3β, which is one of the principal problems discovered within schizophrenia. Overactive GSK3β means a lessened TCF/LEF-transcription factor output, of which lithium can mediate to increase transcription and alleviate the severity of schizophrenic symptoms. This is the mechanism by which lithium acts, but what are some of the other treatments for lithium, and what makes it so effective?
Drugs that treat schizophrenia are often overlapped with bipolar disorder, because the drugs work for both disorders. Comparing the 4 drugs that are commonly used for both, which include lithium, Valproate, Olanzapine, and Quetiapine, lithium can be found to display several benefits. Effective treatment of schizophrenia can be characterized by the ability to take the drug for as long as possible without the downsides of the side effects outweighing the benefits of the drug itself. When a drug is stopped due to this effect, it’s known as treatment failure. Lithium, when compared to the other 3 drugs here, had the longest treatment failure times. It also appeared to be the most effective treatment to prevent relapse or recurrence of bipolar disorder and may prolong the time before complimentary prescribing is necessary.
On that note, a meta-analysis was done on 20 different studies that looked at the effectiveness of lithium and found that as a sole agent, lithium wasn’t as effective as when prescribed with another drug for treating schizophrenia. This is referred to as lithium augmentation, and although some sources disagree, most confirm that this method is the best way to treat either of these disorders.
There are almost no other drugs that can be said to have been the most effective drug for a disorder for over 150 years, but lithium is in that category.
