Q: Dr. Guterson - my husband has two or three manic episodes every year. Which medication is best to help him? A: Far and away, in my experience, Lithium is THE gold standard for mania. One of the central problems when someone is in a state of mania is lack of insight. They simply have no idea that they are not doing well and possibly putting themselves and others at risk - not sleeping, going on spending sprees, sexual promiscuity, driving fast, paranoid and grandiose delusions. Someone who is in a state of mania usually says: “I feel great! Don’t bother me.” With lithium treatment (and the strategy to convince a resistant patient to take lithium is a topic for a different time), I have seen countless times a total turnaround of insight: “Doctor, I can’t believe a few days ago I was getting ready to fly to Paris to steal the Mona Lisa….what was I thinking?” Obviously, the decision for lithium is up to your husband’s psychiatrist. There are certain situations - pregnancy, electrolyte imbalance, kidney or thyroid problems - where lithium is probably contraindicated. Blood levels need to be monitored regularly. But otherwise, I have never seen a medication work consistently so effectively - and with a total turnaround of insight and awareness. “Ah, insight!”, the sages say - if only we all could have that all the time!
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