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Lithobid

Lithium salts are chemical salts of lithium used primarily in the treatment of bipolar disorder as mood stabilizing drugs. They are also sometimes used to treat depression and mania. more...

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Lithium carbonate (Li2CO3), sold as Carbolith®, Cibalith-S®, Duralith®, Eskalith®, Lithane®, Lithizine®, Lithobid®, Lithonate® and Lithotabs®, is the most commonly prescribed, whilst the citrate salt lithium citrate (Li3C6H5O7), the sulfate salt lithium sulfate (Li2SO4), the oxybutyrate salt lithium oxybutyrate (C4H9LiO3) and the orotate salt lithium orotate are alternatives.

Lithium is widely distributed in the central nervous system and interacts with a number of neurotransmitters and receptors, decreasing noradrenaline release and increasing serotonin synthesis.

History

The use of lithium salts to treat mania was first proposed by the Australian psychiatrist John Cade in 1949, after he discovered the effect of first lithium urate, and then other lithium salts, on animals. Cade soon succeeded in controlling mania in chronically hospitalized patients. This was the first successful application of a drug to treat mental illness, and opened the door for the development of medicines for other mental [[problems in the next decades.

The rest of the world was slow to adopt this revolutionary treatment, largely because of deaths which resulted from even relatively minor overdosing, and from use of lithium chloride as a substitute for table salt. Largely through the research and other efforts of Denmark's Mogens Schou in Europe, and Samuel Gershon in the U.S., this resistance was slowly overcome. The application of lithium for manic illness was approved by the United States Food and Drug Administration in 1970.

Treatment

Lithium treatment is used to treat mania in bipolar disorder. Initially, lithium is often used in conjunction with antipsychotic drugs as it can take up to a week for lithium to have an effect. Lithium is also used as prophylaxis for depression and mania in bipolar disorder. Also, it is sometimes used for other disorders, like cycloid psychosis, unipolar depression, migraine and others. It is sometimes used as an "augmenting" agent, to increase the benefits of standard drugs used for unipolar depression. Lithium treatment is generally considered to be unsuitable for children.

Mechanism of Action

The precise mechanism of action of Li+ as a mood-stabilizing agent is currently unknown, but it is possible that Li+ produces its effects by interacting with the transport of monovalent or divalent cations in neurons. However, because it is a poor substrate at the sodium pump, it cannot maintain a membrane potential and only sustains a small gradient across biological membranes. Yet Li+ is similar enough to Na+ in that under experimental conditions, Li+ can replace Na+ for production of a single in neurons. Perhaps most the most interesting characteristic of Li+, is that it produces no obvious psychotropic effects (such as sedation, depression, euphoria) in normal individuals at therapeutic concentrations, differentiating it from the other psychoactive drugs.

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Revisiting the bell jar: Putting young girls under the lenses of patriarchy
From Off Our Backs, 7/1/99 by Spiers, Rebecca Myers

Revisiting the Bell Jar: Putting Young Girls Under the Lenses of Patriarchy

Everyone knows what it's like to call the operator. And everyone knows how crushing the reality is when that particular number has been disconnected. It hurts even more when you scramble for your options and the operator is rude to you. This is how I describe my experience in a "recovery" center (AKA: mental hospital). Except there were hundreds of operators and the whole phone book was redesigned.

At fifteen, I was incarcerated in the Pine Grove Recovery Center located in Hattiesburg, Mississippi. After repeated suicide attempts, my parents and I agreed that it might be helpful to take a trip to the adolescent unit. By then I was desperate, both to get away from my family, and also to stop the self-mutilation that came almost daily. I thought they would help me. I thought they would be nice to me. I thought I would meet other teenagers that were going through the same thing. I thought a lot of things. But one thing that never crossed my mind is that I would lose all identity, personality, and control over my life once I stepped through those doors.

After the needs accessment, I was pulled through double doors to the see the Clinical Assistant ("CA") on duty. My mother was with me (offering me no privacy or comfort) as they rifled through my suitcase removing "dangerous" items. They removed my toiletries (saying that I could swallow them or the alcohol that was in them to harm myself) and put them behind the counter to be removed only twice a day for thirty minutes. They removed my razors (I still bought into the beauty myth) for the obvious reasons. This is how they would control my body.

But then their search got more intense, rifling through every book I had, removing all music (it often had a negative influence--rock and roll is of the devil) and band T-shirts (for above reasons). They interrogated me for half an hour on the content of my books. I had to explain why I carried Marilyn French, Anne Sexton, and Sylvia Plath. To respond to my inquisitor's mysogynistic airs, I explained my need for other women's writing in a very careful way. The Women's Room was a story about a group of housewives. Anne Sexton "reinvented" fairy tales and Sylvia Plath "just has a bad life." They let me keep The Bell Jar, which just happened to be the one that offered me the least hope. This is how they begin to control my mind.

They made me fill out tons of paperwork, including one that asked of any special diet. When I filled in vegetarian, the CA scoffed at me and said, "That isn't necessary. You're just trying to be cool." This is another way that they would control my body.

They made me complete a drug test and a strip down search for dangerous items.

After we went through the standard bureaucratic procedures, my mother left. At once, their smiles disappeared. They forced my to remove my shoes until I could, "clean up my act." They took pleasure in writing the initials EP and SP by my name which stood for Escape Precaution and Suicide Precaution and Suicide Precaution. They threw my point sheet (used to tally up points for my "behavior") at me and sent me to my room for the day. I apparently needed to "rest" and "get used to my surroundings." What I would really be getting used to were days without the sun, being drugged out of my senses, and being treated like shit. I went to my room with only a point sheet for the following day, four outfits, and a worn copy of The Bell Jar and no way to make sense of what was happening.

I slowly put my clothes away. I made no effort to reread the book that had become my Bible over the last couple of months. I carefully studied the point sheet. There were three categories: "Interaction With Others," "Personality," and "Following the Rules." I could get up to three points for each category (three being the most) each day. I assumed that if I followed every rule everyday, then by their quantitative metholodgy, I would get back my shoes and their respect. I was right about the shoes. I was wrong about the respect.

I decided that my "fragile" spirit could make it through to "group counseling" that afternoon. I walked into the room to the faces of fifteen broken spirited teenagers. They seemed as if they wanted to rebel but were all too drugged to do anything. Amidst their curious glances, I stated my name and why I was there. "My name is Rebecca and I'm here because I can't stand to live in the world anymore." The CA officiating the ceremony of self-esteem destruction looked me in the eye and said, "Rebecca is new. She tried to kill herself and it seems like she's somewhat of a poet." A small bit of laughter escaped from the mouths of my peers.

After the humiliation of group was over, they brought me my dinner in the lounge. It was a small cafeteria as dinner with ravioli filled with dead cow (which I had not touched in over three months), potatoes, turnip greens, and a stale roll. I was given two small containers of milk and orange juice to chase the food down.

My wake-up call the next morning consisted of a flashlight in my eye and a loud banging noise. I was to get dressed, sit down to a greasy breakfast of eggs, bacon and a stale biscuit, and then complete my first day in hell.

But first, I had to take my medicine.

Based on my assessment, my psychiatrist had already diagnosed me with bipolar disorder and prescribed an extremely high dosage of Lithobid. I objected but I took it because I had no option--last night during free time I heard my peers filling me in on what happened if you didn't follow the rules. You could be confined to your room or confined to the "quiet room" if you weren't careful. And I didn't want that.

After I started taking that medicine, everything became a blur, with only a few horrific experiences in my memory.

I remember how horrible of an experience group therapy was. I remember when I announced that I was pagan and my psychiatrist told me to shut up. She denounced my religious choice saying that it "was evil and stupid." I remember when I tried to tell our psychiatrists that I was raped. Deciding that it was too hard of an issue to work on, they told me I was just trying to get attention and that it didn't happen. I remember when they gave more attention to my roommate because she was obviously prettier than the rest of us, reinforcing the beauty myth. When she told them that she wanted to be a writer, they assured her that she would succeed. When I tried to join in and tell them that writing was my talent also, they told me (once again) that I was lying and that I would never make it. I remember that when our psychiatrist, who was apparently comfortable at the room temperature, decided that everyone wearing coats (and black coats at that) was rebelling and unionizing to take over the floor. He put us on "floor shutdown" for the rest of the day. We were to stay in our rooms until we could learn what it meant to respect authority. For days after that I had to suffer when I was cold because I was not allowed to wear a coat. To this day, I can't stand to be in my dorm room for more than a few hours at a time.

I remember how hard it was to live with my roommate. I told her that I had kissed my best friend (a girl) and that I found my best friend attractive. Thinking nothing of it, I took a nap. I woke up to find that she had told the whole floor about it. By the next day, it was as if the entire right wing had moved onto my floor and organized against me. I remember when my roommate moved into another room because she was scared to sleep next to me. I remember crying until four in the morning, until I fell asleep still not understanding why that would make her hate me so much.

I remember the scales slowly creeping up from terrible food, no exercise, never being let outside and the effects of my medicine. I remember leaving the hospital after three weeks, weighing thirty more pounds. I also remember going into the emergency room months later because my thyroid gland was on the brink of not working because of my medicine. I also remember that same medicine making me throw up for days and because I didn't show it to the CA on duty, no one believed me and nothing was done.

I remember how they tried to stunt my creativity. I remember them removing my poems about some of my first sexual experience because they considered them indecent. I remember them removing a drawing from my notebook that showed a pair of lips and read, "Why do you hear me when I open my legs but not my mouth?" They also removed other art from my bulletin boards. And damn it, I want my drawings back. I remember when I drew a snake in "art therapy," thinking nothing of it. But since, in their narrow Christian minds, it was a symbol of Satan, I received zero points that day.

The one thing that I remember most, the incident that rings the clearest in my mind is the "quiet room." After two weeks in the hospital, I made the most desperate attempt on my life yet. For the last week, I had saved pieces of the tin foil juice lids. I fashioned them into a knife like structure. I also removed the metal eraser holders from my pencils. I had managed to sneak in the hospital in a bra with an underwire. I removed it from the bra. Alternating between those tree tools, I began to carve on every part of my body that I could find, hoping to bleed to death before they found me. My roommate saw and reported me and before I knew it they had taken me to the padded cell they called the "quiet room." They didn't hug me or ask me why I had made an attempt on my life. They just left me, with tears streaming down my eyes and blood streaming down my wrists with the reminder that I was a danger to myself and everyone around me. The only contact I had with others was when they threw my journal at me and told me to write an essay on why I shouldn't kill myself (I faked it), when they slid my meals through the door, and when I had to use the restroom.

But often it was the things that I didn't remember that stuck out. I couldn't remember the words to any of the songs that I loved before my hospitalization. Only one came to mind. It's the one that goes, "Early in the morning/Rise into the street/Light me up that cigarette/And I strap shoes on my feet/...Love's what I got/Don't start a riot/You'll feel it when the dance gets hot...hot" I would sing that song over and over again, ensuring that as long as I could remember that song, I would still have some connection to the outside world and to my sanity.

They let me out three days after my suicide attempt and confinement, saying that I was better. In actuality, my insurance was running out. I knew I wasn't any better than when I came in, even that I was worse, but I smiled and agreed because I had to get out of the hell hole that I was in. It wasn't until almost two years later that I stopped my rituals of self-mutilation and until I could function.

After three years, it still hurts to remember and write this. I had to stop to remember and even stop to cry. It still hurts to know that the people who were supposed to help me, that were supposed to care the most, contributed more to my emotional and spiritual downfall. It still hurts to know that when I needed to talk to someone the most, they only let me see my therapist once every three days. It still hurts to know that they never once considered that it might have been my fucked up family, the horror that other kids put me through or the sexual abuse I had experienced and not a chemical imbalance that made life in this world unbearable. But what hurts even more is that this is still happening to people. So I urge you to reconsider hospitalization. I urge you not to put your daughters, your sisters, your mothers, or even your best friends through this. I urge you to remember that the first step in dismantling the patriarchy is not listening when they tell you that you are the one with problem.

And then, my sisters, is the work able to move on.

Illustration (Woman removing her head)

Copyright Off Our Backs, Inc. Jul 1999
Provided by ProQuest Information and Learning Company. All rights Reserved

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