How A Life-Saving Drug Hinders Creativity
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Introduction to Dr. Jamison and Lithium
Kay Redfield Jamison is a Professor of Psychiatry at John Hopkins. She specializes in treating bipolar disorder, and is unusual in that she suffers from bipolar herself. She has authored the standard, medical textbook on manic-depressive illness that was elected “Most Outstanding Book in Biomedical Sciences” in 1990. She has also written several books concerning bipolar disorder, creativity, madness, and lithium.
3% of the American population is bipolar. The illness has been romanticized in the West, and is often associated with “creative geniuses,” also most of its sufferers are not. There is evidence that bipolar individuals are drawn to the arts, notably a study done by Dr. Katherine Rankin at UCSF who determined that: “People with affective disorders tend to be over-represented in the artist population (especially those with bipolar disorder). Bipolar disorder may carry certain advantages for creativity, especially in those who have milder symptoms” (Collingwood). Bipolar disorder is characterized by cyclic manics and depressions. Manics are marked by boundless energy, productivity, enthusiasm, creativity, hyperactive thinking, restless behavior, and often include promiscuity and spending obscene amounts of money. The second half of bipolar disorder is severe depression, which can last for several months. One of main causes of death in bipolar patients is suicide. Bipolar disorder cannot be cured, but it can be managed with psychiatric treatment. The frontline drug is lithium, a mood stabilizer. Lithium renders creativity, intense emotions, and sensitivity to one’s environment inaccessible to the lithium-user, which can be debilitating to creative people. Lithium’s stifling (albeit life-saving) effect is one of the main reasons bipolar individuals stop taking their medication, especially if they are involved in artistic pursuits. History of Lithium
Historically, lithium was used to treat gout. By 1870, neurologist Silas Mitchell prescribed lithium for convulsions (Shorter). The first time lithium was used to treat mania was in 1871 by Professor William Hammond. He believed it “diminish[ed] the amount of blood in the cerebral vessels, and [calms] any nervous excitement that may be present” (Shorter).
In her autobiography An Unquiet Mind: A Memoir of Moods and Madness, Jamison describes her lifelong struggle with bipolar disorder and lithium. She notes that lithium: “Prevents my seductive but disastrous highs, diminishes my depressions, clears out the wool and webbing from my disordered thinking, slows me down, gentles me out, keeps me from ruining my career and relationships, keeps me out of a hospital, and alive” (86). |
Adverse Effects
Lithium is a narrow safety margin drug, meaning adverse effects occur at high rates, and often concurrently with the medication’s benefit. The precise mechanism for how lithium is metabolized is not fully understood. “Profound” lithium toxicity occurs at three times its therapeutic dose, with plasma concentrations exceeding 1.5 mmol Li+/liter (Sansone). Lithium concentration within the body can change depending on water intake, salt levels, diet, hormones, elevation shifts, and vigorous exercise (Harvey). Hyponatremia, sodium-depleting diuretics, ibuprofen, and aspirin cause lithium retention. Because these secondary drugs are easily available and commonly used, lithium-users may be unaware of negative drug-drug interactions and accidentally enter a toxic state (Harvey). If taken concurrently with antidepressants, lithium use can lead to serotonin syndrome (Sansone). Lithium is a teratogen, and can cause nausea, ataxia, slurred speech, vomiting, tremors, convulsions, and comas. Those suffering lithium toxicity often appear to be drunk. If the patient experiences “disturbances of fluid balance,” they can overdose on a low therapeutic level of lithium. If the patient takes too little lithium, or drinks caffeine (increasing the rate of expulsion from the body), they risk relapsing into manic or depressive states. Under severe toxicity, non-reversible neurological damage can occur. While essential to treatment, lithium can be a dangerous and unpredictable drug. Lithium has a high first pass effect, where 95% is renally excreted. Lithium is also excreted via breast milk, sweat, and saliva (Sansone).
Effects on Creativity
Jamison experienced each of these adverse affects when treated with lithium. However, Jamison was most horrified by how: “Lithium impaired my concentration, attention span, and affected my memory. Reading, which had been at the heart of my intellectual and emotional existence, was suddenly beyond my grasp” (92). Lithium-users often describe it as a “gauze,” which dampens their experiences and makes life seem “cloudy.” Jamison describes one of her manics, and the deadening effects of lithium, as:
I found myself gliding, flying, now and again lurching through cloud banks and ethers, past stars, and across fields of ice crystals [...] I remember singing “Fly Me to the Moons” as I swept past those of Saturn, and thinking myself terribly funny. I saw and experienced that which had been only dreams, or fitful fragments of aspiration. Long since the voyage of my mind and soul, Saturn and its icy rings took on an elegiac beauty. Was it real? Well, of course not. Long after my psychosis cleared, and the medications took hold, it became part of what one remembers forever. The intensity, glory, and absolute assuredness of my mind’s flight made it very difficult for me to believe, once I was better, that the illness was one I should willingly give up. My family expected that I would be appreciative of lithium, and take in stride having normal energy and sleep. But if you have had stars at your feet and the rings of planets through your hands, are used to staying up all night for days and weeks in a row and now cannot, it is a very real adjustment to blend into a three-piece suit schedule (90). As a writer, doctor and artist, lithium hindered Jamison’s ability to comprehend literature or scientific research for several years. It took a decade for the adverse affects of lithium to “wear off.” The creative advantages of bipolar she experienced, including hallucinations, optimism, charisma, and inspiration, became negligent (70). Jamison describes her own mild manics as “the best version of herself,” and bipolar disorder as “a distillation both of what is finest in our natures, and of what is most dangerous” (20). She credits lithium for saving her life, and also for diminishing its beauty. Jamison has provided the medical community and general public an unflinching reality of the benefits and sacrifices of lithium use. Her research has been instrumental in re-structuring bipolar treatment programs and bringing greater understanding to this often allusive and difficult mental illness. References Collingwood, Jane. "The Link Between Bipolar Disorder and Creativity." Psych Central (2015). Web. 2 Apr. 2016. Harvey, Norman S., and Sandra Merriman. "Review of Clinically Important Drug Interactions with Lithium." Drug Safety 10.6 (1994): 455-63. Web. 20 Mar. 2016. Redfield Jamison, Kay. An Unquiet Mind: A Memoir of Moods and Madness. New York: Random House, 1997. Print. Sansone, ME, and DK Ziegler. "Lithium toxicity: a review of neurologic complications." Clinical Neuropharmocology 8.3 (1985): 242-48. Web. 18 Mar. 2016. Shorter, E. "The History of Lithium Therapy." US National Library of Medicine National Institutes of Health 11.2 (2009): 1-8. Web. 22 Mar. 2016. |
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