I personally know her, and she is known to be critical of all psychiatric drugs and has written many papers on the limits of the evidence base for psychiatric drugs and how the harms have been minimized.
Most of what she says is spot on. As I mentioned above, it is quite clear that people who stop lithium are worse off. What is not clear is whether that is because of withdrawal from the drug or the illness itself (knowing as we do many people without any drugs can go many, many years without any recurrence).
The main point I take issue with is she claims there is nothing about lithium, other than its sedative properties which are helpful. That is just categorically untrue and you don't need an RCT to show that. the initial Cade Study of lithium from 1949 compared depressives, manics, and schizophrenics. They received toxic doses. The manics were the only ones to achieve relief with lithium and some of the patients had been manic for years. They had been on many sedative drugs (sedatives have long existed) and not improved, and the fact that the schizophrenics did not get a benefit, shows that this was more that a sedative property of the drug. For a minority of individuals with manic-depressive illness, lithium is to put it simply, a wonder drug. Not most people, but for quite a few. Strong family history of manic depressive, a manic predominant illness, and MDE course, the absence of rapid cycling, and the absence of any prior trials of antidepressants (people who receive antidepressants respond more poorly to lithium) are good predictors of treatment response.
Partly based on Moncrieff's work, and my own clinical experience, I take the approach (as described above) of avoiding using medications for maintenance as far as possible. I do not believe that it is necessary in the majority of cases. As this is a minority opinion it is important that you discuss this with the patient, and document it, having given the patient a choice about the appropriate strategy, and justify why, with appropriate monitoring (and where appropriate psychotherapy), you are forgoing the recommended practice of maintenance medications. I also provide "rescue kits" of antipsychotics and benzodiazepines that they can take if they recognize they are becoming manic. Contrary to popular belief, patients know when they are becoming manic (converely, patients don't know when they are becoming depressed). Unfortunately they may enjoy the early phase and forgo medication. This is why I as far as possible enlist the support of family and provide them with education about recognizing early warning signs, and how to start medications.
in terms of ESRD - this really only occurs when people are receiving too high doses, are not receiving appropriate monitoring, are unreliable with the medications etc. Even in those patients the risk <1%. With careful monitoring, and guidance, the risk is much less. Unfortunately, the US is way behind the times in terms of adequately monitoring these things and provide good guidance to patients on lithium. Another point to mention is that in the US 0.8-1.2mEq/L is taken as the standard level. This is too high. The data, and what is done in the rest of world suggest 0.6-1.0 is the reasonable therapeutic range in patients in manic depressive illness. for recurrent unipolar depressives, 0.4-0.6 is the recommended therapeutic range.
that is not what i said at all. please read a book or some clinical guidelines
