Talk:Lithium (medication)/Archive 1

Archive 1

7up

About 7up. Maybe the 7 is because of the atomic mass of the most common isotope of Li. :) --AstroNomer 20:26, Dec 16, 2003 (UTC)~

An important thing to me is that Lithium can be found as one of the components of sun light acting like a philological regulator in human... that is the point in the need of sun light for metal health in human being.

Lithium is found in sunlight? Somebody's trying to say something here, but it doesn't make any sense. What does this have to do with 7-Up? (Quiet Riot rulez!!!)MrShoggoth 01:19, 7 March 2006 (UTC)

Title change

I believe this should be entitled simply "Lithium", with a note at the top of the article on Li the element referring one to this page. At least in the US, "lithium salts" is not used. Being a relative newcomer to the page, I am reluctant to so alter it myself. Sfahey 22:06, 15 February 2006 (UTC)

This is a medical article on Lithium Salt. For information on Lithium there is another page. --Forzan 22:02, 1 March 2006 (UTC)

Again, in twenty years as a physician I have never heard a doctor or patient refer to "lithium salts."Sfahey 23:37, 1 March 2006 (UTC)

I agree that "lithium salt" is confusing terminology. Better titles would be "Lithium carbonate" (with the other salts redirecting to that page) or "Lithium_(pharmaceutical)".

Perhaps "lithium salts" is used outside the US? MrShoggoth 01:19, 7 March 2006 (UTC)

Unless some non-American insists otherwise, it should be changed, I think just to "Lithium", gong to a disamb. page to differentiate from the element Li. I don't know how to go about changing a title though, except cutting and pasting this one onto a new title. Sfahey 16:38, 7 March 2006 (UTC)

The title adequately reflects the content. It contains information on the most common medical lithium preparations (lithium citrate and carbonate). I have seen this term in use in Europe. JFW | T@lk 17:11, 7 March 2006 (UTC)

The new disambiguation text is good enough for me. MrShoggoth 06:59, 16 March 2006 (UTC)

This article needs references badly. Fuzzform 02:46, 24 March 2006 (UTC)

Redirect

I'm going to redirect the lithium salts page to here, since it was not really about lithium salts per se, but only their use as mood stabilizing drugs. — Preceding unsigned comment added by Sbharris (talk • contribs) 04:39, 25 June 2006 (UTC)

Use in Ancient Rome

i'm not going to edit this page, but I'd have the first line say something like "The use of lithium salts to treat mania was first introduced by physicians of ancient Rome, when doctors recommended bathing in the springs in northern Italy which are abundant with the salts." ... I just have no citation but I've read it time and time again — Preceding unsigned comment added by Lieutenant Colonel Frank Slade (talk • contribs) 02:14, 10 July 2006 (UTC)

Psychotropic effects

A previous editor changed the word "psychoactive" in the following sentence to "recreational":

"Unlike other psychoactive drugs, Li+ produces no obvious psychotropic effects, (such as euphoria) in normal individuals at therapeutic concentrations."

Lithium does not induce euphoria, hallucinations, or psychosis at therapeutic doses -- its undesired side-effects are almost completely negative in nature, something which is not true of most other psychoactive drugs. There's certainly no danger of lithium ever being misused as a recreational drug. -- The Anome 09:33, 27 October 2006 (UTC)

plasma concentrations

Hi, maybe to physicians is obvious but to average man I don't think so. It should be stated clear the "plasma concentrations" of lithium ion is referred only to the treatment period because normal level is about zero! Or well the less the better but surely less than 0.1 mmol Li+/litre. That is lithim ions are present in human body only in ultra traces because of absorption from compounds rarely found in food. Emilio 11:17, 21 April 2007 (UTC)

Redundant salts

isn't it more than a little redundant to say that lithium sulfate is the sulfate salt and lithium citrate the citrate?Toyokuni3 (talk) 20:40, 15 September 2008 (UTC)

Citation

It is written in the article: "All of these were forced to remove lithium in 1948" but without any citation. I doubt that because it is also written that it was rediscovered in 1949 (by John Cade) after its effect was forgotten for many years. --134.155.99.42 18:52, 17 May 2007 (UTC)

1948 was probably a bit early; I believe 1949 or 1950 is correct. Keepcalmandcarryon (talk) 22:56, 19 February 2010 (UTC)

FDA approval

I've found sources stating that the US FDA approved lithium in 1974; others place the approval in 1970. Keepcalmandcarryon (talk) 22:57, 19 February 2010 (UTC)

Lithium ororate

I was almost going WP:BOLD, but lithium ororate has no therapeutic value whatsoever, and is peddled by naturopaths as the "natural" alternative to sucky lithium carbonate/citrate. It's just woo. — Preceding unsigned comment added by 201.53.74.31 (talk) 10:43, 3 December 2010 (UTC)

Harmful Effects

This section seems to begin in the middle of a paragraph. —Preceding unsigned comment added by 68.142.55.186 (talk) 00:09, 4 January 2011 (UTC)

Lithium toxicity in overdose section

"Lithium is, for the most part, completely incapable of being considered life threatening": this is bad grammar (something can't be "for the most part" as well as "completely"). It also contradicts the history section: "The rest of the world was slow to adopt this revolutionary treatment, largely because of deaths which resulted from even relatively minor overdosing". — Preceding unsigned comment added by 219.90.204.119 (talk) 13:18, 27 May 2007 (UTC)

dpower80@yahoo.ca writes:

Additional notes: Lithium can be very toxic in higher concentrations, blood concentration levels of 4.0+ are considered fatal, doses higher than 2.0 can cause damage to the heart and kidneys, leading to dialysis in severe cases. I took 20 pills (intentionally) and was fortunate enough to get my stomach pumped in time at SCGH, and this is what a doctor told me based on the information he recieved from poison control. — Preceding unsigned comment added by 216.121.216.195 (talk) 01:36, 30 June 2008 (UTC)

A blood concentration of 4.0 would be utterly completely fatal if it wasn't impossible to achieve. MMOL measurements in this very article show you that 0.6 MMOL to 1.0 MMOL is the theraputic range - 1.2MMOL and above are dangerous and 1.5MMOL and above can be fatal - 2.0 would certainly be fatal and I believe it would be impossible to get a 4.0MMOL reading as you would be dead long before reaching that level. Ive taken Lithium for several years and its completely safe if monitored properly and titrated correctly.

If this is what a doctor told you his information is very very very very wrong and also dangerous to his patients. — Preceding unsigned comment added by 122.111.78.112 (talk) 07:39, 29 September 2009 (UTC)

I'm not sure 'completely safe' is a proper term for most any medication, especially one who's mechanism is poorly understood. However, if your doctor prescribes it and you don't notice negative side effects, I would continue with his recommendations. Bloomingdedalus (talk) 18:25, 18 June 2011 (UTC)

7-up

7-up section says "It contained the mood stabiliser lithium carbonate [...] Lithium citrate was removed from 7 Up's formula in 1950."

So, did 7-up contain lithium citrate or lithium carbonate? Or did it contain both at different times and the paragraph doesn't make this clear? —Preceding unsigned comment added by 168.88.70.34 (talk) 10:29, 24 August 2010 (UTC)

I believe it was only lithium citrate, but I don't have the specific reference at hand, so I'm not going to change it. Bloomingdedalus (talk) 18:30, 18 June 2011 (UTC)

Film and Pop Culture References

Removing them - they do nothing to inform the reader of anything regarding the use of lithium medicinally and may convey contrary information to otherwise uninformed readers. (For example, Zach Braff's character in Garden State stops taking lithium, for people with psychotic disorders, which his character did not have in any meaningful sense [perhaps a little sociopathy at times], this may be a very poor idea). If you enjoy the relevance of the medication on popular culture, it would look better to put this information into a paragraph discussing the vast impact the use of the drug over the years has had on media and fiction, which is of relevance, not simply a list of every reference in every popular media you can find. The beverage references are relevant because it indicates a time when Lithium was vastly distributed uncontrolled to the populace, not simply a quote from a film or song. Bloomingdedalus (talk) 18:33, 18 June 2011 (UTC)

Need for big revivision / rewriting

• This Article is talkative much like in chat

within pharmacology and side effectsand in the beginning paragraphs mucl like Doogle traclatin anf pasting.

• Även otherwise there are redundecies.
• Factuak errors like there is no real undestanding,
• Bad wikifiering att the beginning.
• En expert opinion will help.

Själv can ja inte skiva rga Lithiun tremoe 85.226.151.86 (talk) 13:51, 25 December 2011 (UTC)

What is a "high level" of lithium in normal drinking water?

The article mentions supposed benefits from higher-than-average lithium levels in drinking water, but it doesn't mention what constitutes such a level. I.e. what amount of lithium (in ppm or ppb) is typical for drinking water supplies, how much is a "low concentration" (say 5% percentile) and how much is "high" (say 95% percentile)? If anybody has that information please add it. -- 77.21.178.165 (talk) 13:38, 19 February 2012 (UTC)

I answered the question on the lithium talk page. --Stone (talk) 07:58, 20 February 2012 (UTC)

SILENT

I question whether "SILENT" should be included in this article. The current citation appears to be the only extensive treatment of the concept in the literature, and it appeared eight years ago in a low impact factor journal. There have been a few small primary studies and case reports, but not enough to convince me that "SILENT" (moniker or condition) has received the kind of acceptance or review that would justify inclusion in the article. Keepcalmandcarryon (talk) 02:08, 29 June 2013 (UTC)

Agree - I was going to flag the original section as debatable and unreferenced, but decided to try and improve it instead prior to your edit. The point that influenced me to try to keep a mention of it rather than getting rid of it entirely is that some, but not all, manufacturers of lithium carbonate mention either SILENT or a description of the purported features in their SPC (Summary of Product Characteristic) sheets - particularly Norgine. Personally, I'm sceptical about it in the absence of further data (particularly outside the context of the sequelae of serious overdoses), but as I prescribe lithium I could be seen as having a COI. 86.8.170.224 (talk) 21:30, 29 June 2013 (UTC)

Lithium is poison because it is a metal

While lithium is great "if it works," it is a poison (potentially) because it is a metal. Any "digestible" (absorbable) metal inside a person is potentially poisonous because it "falls" to the bottom of the kidneys (liver?) and can't be filtered out. Lithium is a light metal which is maybe why it can be used for so long with some people? (The threat is drastically reduced for trace elements we need, like zinc (which is heavy); and the lighter metals, sodium and potassium for electrolytes. Relatively small amounts)

My wording sounds pov, but it needs to be placed in the article somewhere IMO. Or maybe one sentence with a link to some appropriate "metal poisoning" article. Thanks. Student7 (talk) 00:10, 23 June 2014 (UTC)

Most stuff is poisonous if you take enough. We need high quality refs. Doc James (talk · contribs · email) (if I write on your page reply on mine) 01:58, 23 June 2014 (UTC)

Well, there's http://emedicine.medscape.com/article/242772-overview, and http://jasn.asnjournals.org/content/11/8/1439.full for starters. And it's missing in metal toxicity as well. I mentioned it there, as well.

Even for salt, I don't think we are advised to consume that much metal-containing substances. Cubic centimetersgrams, millimetersgrams or even micrometersgrams, rather than litersgrams. Student7 (talk) 12:41, 23 June 2014 (UTC)

First ref does not say it is a poison or mention that it is a metal?

The second is a primary source. We much prefer secondary sources. Doc James (talk · contribs · email) (if I write on your page reply on mine) 20:59, 23 June 2014 (UTC)

http://www.nlm.nih.gov/medlineplus/ency/article/002667.htm NIH, a secondary source

http://toxnet.nlm.nih.gov/cgi-bin/sis/search/a?dbs+hsdb:@term+@DOCNO+3351 Different NIH document

Don't we know that lithium is a metal? And that any compound containing it in any quantity is a metal?

http://www.patient.co.uk/doctor/lithium-pro

http://bipolar-disorder.emedtv.com/lithium/lithium-toxicity.html Points out that toxic dose is close to the normally prescribed medicinal dose

http://www.uptodate.com/contents/lithium-poisoning subscription required. Addresses lithium poisoning

http://medical-dictionary.thefreedictionary.com/Lithium+toxicity Tertiary source (medical dictionary). But since it's been used for well over a century, the toxic affects have been known for some time

http://www.hindawi.com/journals/crin/2013/839796/ I guess you'll say this is a primary source. (Odd how many primary sources report toxicity. Do you suppose there is something to it? I guess we are not free to speculate on dozens of reports)

http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2811%2961516-X/abstract Lancet secondary article disagrees with findings about toxicity!

http://www.drrichardhall.com/Articles/lithium_therapy.pdf Agrees with everybody else that toxic levels are close to therapeutic levels

http://www.livinghealthy360.com/index.php/causes-symptoms-treatment-lithium-toxicity-17526/ Seems to believe that other drugs interact to cause toxicity

http://www.nytimes.com/health/guides/poison/lithium-overdose/overview.html NY Times health support

http://www.sigmaaldrich.com/catalog/product/aldrich/203629?lang=en&region=US Seems to say that it is a metal. Cannot evaluate site WP:RS. Looks good to me.

http://chemwiki.ucdavis.edu/Inorganic_Chemistry/Descriptive_Chemistry/Compounds/Carbonates Chemistry. May be useful somewhere. Student7 (talk) 00:03, 24 June 2014 (UTC)

No one is denying that lithium is a metal and that lithium can be poisonous. The statement was "it is a poison because it is a metal" that I had issue with.

Some of the sources you have provided are excellent specifically this lancet paper [1]

Now what do you want to say with this? Doc James (talk · contribs · email) (if I write on your page reply on mine) 02:30, 24 June 2014 (UTC)

Group project for treatment of bipolar disorder

LithiumCHM333 (talk) 20:59, 10 March 2015 (UTC)For an undergraduate class my group and I are to edit Wikipedia in regards to the the topic: treatment of bipolar disorder with lithium. In addition we need to answer why lithium is used, and why not sodium or potassium. Due to the current formatting of this page, we believe it is in our best interest to create a new page that goes in depth with the treatment of bipolar disorder and the potential mechanisms. We plan on linking our page from this one under a subsection of medical uses.

it is not at all clear that the content you want to generate will be encyclopedic. are you working with Project Education? I created a noticeboard report [Wikipedia:Education_noticeboard#undergrad_class_working_on_lithium here] - please talk to them. Jytdog (talk) 22:28, 10 March 2015 (UTC)

My group members and I will be editing this Wikipedia page until March 31st. We plan to expand on the potential mechanisms of action in terms of neurotransmitters, transcription factors, and certain signalling pathways. We would like to know what section would be best for us add our answer to why lithium is used instead of sodium/potassium in terms of biochemistry. Also, what kind of images would benefit this page?LithiumCHM333 (talk) 04:20, 26 March 2015 (UTC)

The key is to use high quality secondary sources. The reason lithium is used is because in RCTs it results in improved outcomes. The exact mechanism is less important but can go in the mechanism section. Doc James (talk · contribs · email) 09:30, 26 March 2015 (UTC)

content about 'recent' work based on source from... 1999

Cut from the article and pasted here:

<blockquote?Recent research suggests three different mechanisms which may or may not act together to deliver the mood-stabilizing effect of this ion. The excitatory neurotransmitter glutamate could be involved in the effect of lithium as other mood stabilizers, such as valproate and lamotrigine, exert influence over glutamate, suggesting a possible biological explanation for mania. The other mechanisms by which lithium might help to regulate mood include the alteration of gene expression. The signaling systems and targets of Lithium affect transcription factors, which in turn alters gene expression. Lithium treatment was found to be inconclusive towards levels of c-fos, a component of the AP-1 transcription factor. Lithium is proposed to have a bimodal mechanism of action for regulating AP-1 activation. Where stimulated AP-1 binding to DNA was found to be weakened while basal AP-1 levels were found to be increased.

Other systems found to be modulated by lithium include:

• transcription factor cyclic AMP responsive element
• transcription factor NF-kB
• G-proteins
• Nitric oxide synthase type-2
• Glial fibrillary acidic protein
• Polyamine enzymes
• increased mRNA neuropeptide Y and somatostatin
• decreased cholecystokinin
• increased bcl-2 protein
• 2’,3’-cyclic nucleotide 3’-phosphodiesterase

References

This is mostly based on one source that is 16 years old and another that is 12 years old, and is otherwise unsourced. This is not OK. Jytdog (talk) 15:24, 26 March 2015 (UTC)

new content moved here

This is too WP:TECHNICAL and there are some mistakes in it.. don't have time to fix now but it needs revision.

Glutamate and NMDA receptors

Glutamate is a reasonable target for mood stabilization because it is a stimulatory neurotransmitter that has found to be elevated during mania. The NMDA glutamate receptor is structurally complex and is administered in several phychiatric disorders. Normally, Mg will bind to the NMDA receptor and inhibit activation, however when glutamate and glycine bind to the receptor simultaneously, Mg is displaced and the receptor is then activated. This activation increases the available glutamate for post synaptic neurons. The role of Lithium in this process is to further compete with Mg at the NMDA glutamate binding site which stabilizes glutamate neurotransmission as the NMDA receptor is down-regulated which increases glutamate re-uptake which restores glutamate equilibrium. This effect generally reduces glutamate-induced activation and therefore has neuroprotective potential. It has been noted that the NMDA receptor is affected by other neurotransmitters. Lithium administration enhances serotonergic neurotransmission by facilitating the post synaptic serotonin 5-HT1A receptor, which in turn activates the NMDA receptor. This hypothesis is thought to be one of the pathways that Lithium provides long term mood stabilization and anti-manic properties. It has been found that these effects specific to lithium have not been observed in other monovalent ions such as Rb and Cs, and common anti-depressants. Lithium has been shown to reduce dopamine activity, dopamine normally increases NMDA receptor activity via dopamine DI receptors, this is also decreased by the actions of lithium on dopamine.

GABA receptors

GABA is an inhibitory neurotransmitter that plays an important role in regulating dopamine and glutamate neurotransmission. It was found that patients with bipolar disorder had lower GABA levels, which results in excitatory toxicity (increased excitatory neurotransmission) and can cause apoptosis(cell loss). To counter this, lithium reduces the levels of pro-apoptotic proteins by stimulating the release of neuroprotective proteins. Also, lithium is known to increase levels of GABA, which causes a decrease in glutamate levels, down regulating the NMDA receptor.

Cyclic AMP secondary messengers

Cyclic AMP second messenger system is shown to be modulated by lithium. Lithium was found to increase the basal levels of cyclic AMP but impairs receptor coupled stimulation of cyclic AMP production. It is hypothesized that the dual effects of lithium are due the inhibition of G-proteins that then mediate cyclic AMP production. Receptor mediated production of cyclic AMP is controlled by a stimulatory G-protein, Gs and a counter balancing inhibitory G-protein Gi. Under basal conditions, cyclic AMP production is inhibited by G-protein influence through activation of protein kinase A (PKA). PKA regulates phosphorylation of ion channels cytoskeletal structures, and transcription factors. The cAMP response element binding element (CREB) protein can be activated from the mentioned. It affects the brain-derived neurotrophic factor (BDNF) and B-cell lymphoma-2 (bcl-2) genes which may play a role neuroplasticity. The levels of BDNF are decreased in patients with bipolar disorder. After treatment with lithium, the BDNF and bcl-2 levels are shown to have increased. Increased basal activity of cyclic AMP levels caused by lithium at concentrations of 2mm/L may occur due to lithium reducing activity of Gi by shifting equilibrium between a free active conformation and an inactive heterotrimeric conformation towards the active form. The action of lithium reduces the magnitude of fluctuations in cyclic AMP levels by increasing the lowest basal levels and decreasing maximal stimulated increases, thus stabilizing the activity of the signaling systems. Over a long period of lithium treatment, cAMP and adenylate cyclase levels are further changed by gene transcription factors.

Inositol depletion hypothesis

Lithium treatment has been found to inhibit the enzyme inositol monophosphatase, leading to higher levels of inositol triphosphate. This effect was enhanced further with an inositol triphosphate reuptake inhibitor. Inositol disruptions have been linked to memory impairment and depression. It is known with good certainty that signals from the receptors coupled to the phosphoinositide signal transduction is effected by lithium. Phosphoinositides are important signaling molecules in receptor mediated signal transduction that play a role in central nervous system response. The mechanism starts by activation of a specific Phosphoinositide receptor that results in hydrolysis of phosphoinosital-4-5-biphophate (PIP2) into inositol triphosphate (IP3) and diglyceride through phospholipase C directed activity. PIP2 and diglyceride cause the activation of Protein Kinase C (PKC) and release of intracellular Calcium. IP3 is then phosphorylated by inositol 1-phosphatase (IPPase) and IMPase which results in the recovery of myo-inositol (mI) which is the main reactant in the Phosphoinositide cycle. It is hypothesized that lithium causes the reduction of IMPase and IPPase which lowers cellular levels of mI resulting in the inhibition of the Phosphoinositide cycle.

myo-inositol is also regulated by the high affinity sodium mI transport system (SMIT), resulting in the extracellular mI entering the cell. Lithium is hypothesized to inhibit mI entering the cells and mitigating the function of SMIT.

Animal studies provide uncertain data to support the two part hypothesis. Myo-inisitol levels obtained from sampling the pre-frontal cortex were the same in patients showing signs of mania and patients treated with lithium. It has been reported that lithium treatment has been correlated with decreased mI levels in brains of children which demonstrated reduction in mania symptoms. IMPase and IPPase concentrations are unaffected in normal mood patients when they are exposed to lithium showing that there is lack of evidence for the inositol depletion hypothesis. There is yet sufficient evidence of a direct correlation between lithium and homeostasis of inositiol. Impacts of lithium on phosphoinositide concentrations are different depending on the brain region, cell cycle and endogenous inositol cycles in that region of the brain. This effect was enhanced further with an inositol triphosphate reuptake inhibitor. Inositol disruptions have been linked to memory impairment and depression.

Protein kinase activity

Protein kinase C (PKC) is found through the brain and effects pre and post-synaptic neurotransmission. PKC is activated by the neurotransmission of the phosopinositide cycle. PKC phosphorylates myristoylated alanine-rich C-kinase substrate(MARCKS), which plays a role in neuron excitability, modulation of gene expression and cell plasticity. Animal studies show that there are increased PKC levels in the pre-frontal cortex of organisms exhibiting mania and bipolar disorder compared to control samples. Within two weeks of lithium treatment at therapeutic concentrations, PKC in platelets of humans with mania had been significantly reduced. Lithium treatment was shown to decrease levels of MARCKS specifically within the hippocampus though the exact mechanism of PKC with regards to bipolar disorder is not known.

GSK3-B

Lithium was proposed to deactivate the GSK3β enzyme. GSK3β normally phosphorylates the Rev-Erbα transcription factor protein stabilizing it against degradation. Rev-Erbα in turn represses BMAL1, a component of the circadian clock. Hence, lithium by inhibiting GSK3β causes the degradation of Rev-Erbα and increases the expression of BMAL which damps the circadian clock. Through this mechanism, lithium is able to block the resetting of the "master clock" inside the brain; as a result, the body's natural cycle is disrupted. When the cycle is disrupted, the routine schedules of many functions (metabolism, sleep, body temperature) are disturbed. Lithium may thus restore normal brain function after it is disrupted in some people. Lithium regulates cytoskeleton protein phosphorylation and function; as a result it affects the neuronal structure. Microtuble-associated proteins(MAPs) such as tau and MAP1B is phosphorylated by lithium, which stabilizes the neuronal cytoskeleton networks.

Protein phosphorylation of cytoskeleton is inhibited by glycogen synthase kinase-3B101. Desphosphorylation of tau at the glycogen synthase kinase-3 site caused by lithium enhances binding of tau to microtubules promoting microtubule assembly. In contrast, dephosphorylation MAP1B decreases ability to bind and stabilize microtubules. Opposing effects of dephosphorylation of tau and MAP-1B promoting microtubule disassembly and assembly respectively causes lithium inhibition of GSK-3.

GSK-3 is an enzyme that is responsible for the regulation of glycogen synthesis. It is directly involved in gene transcription, synaptic plasticity, cell structure and cell resilience. GSK-3 is also implicated to play a role on mood regulation. GSK-3 is shown to be activated in conditions of chronic stress or prolonged exposure to dopamine during periods of mania and is exhibited causation of hyperactivity in mice. Lithium directly inhibits GSK-3 regulation of serine-9 phosphorylation. Inhibition of GSK-3 activates the Akt neurprotective pathway. Inhibition of GSK-3 is not shown to produce anti-depressant effects with great reliability but many studies have shown anti-depressant like effects. In rat models of depression, lithium has shown to increase synaptic plasticity and decrease GSK-3 expression though there are conflicting studies demonstrating that lithium has poor efficacy in the treatment of depressive phase of bipolar disorder.

Intracellular calcium

In 2014, it was proposed that lithium treatment works by affecting calcium signaling by antagonizing N-methyl-d-aspartate (NMDA) receptors and inhibiting inositol monophosphatase (IMP) to synergistically block the inflow of calcium into neurons from both external and internal calcium stores.

Maintenance of calcium homeostasis is critical; dys-regulation of intracellular calcium is correlated with bipolar disorder. Subjects with bipolar disorder exhibit elevation of intracellular calcium at both receptor-mediated and basal levels. Calcium levels are a quantitative measurement of the state of the illness rather than a symptom of the bipolar disorder. Lithium has shown effects on intracellular calcium signalling. Lithium blocks the uptake of calcium by cells in individuals with and without bipolar disorder. The reduction in calcium uptake by cells is due to the activation of NMDA receptors. Lithium also activates metabotropic glutamate receptors.

Lithium decreases intracellular calcium stores and levels. Lithium functions by blocking excitotoxic processes, in part by calcium level modulation. Excitotoxic processes are hypothesized to be induced by kainate through the modulation of calcium entry inhibiting calpain proteases involved in apoptosis.

References

happy to discuss, just not right now. Jytdog (talk) 12:18, 31 March 2015 (UTC)

Would you like us to attempt to make edits in similar terms to the ones you made on oxidative metabolism and dopamine?LithiumCHM333 (talk) 18:51, 31 March 2015 (UTC)\

"us"? you do know that the username policy is one person per account, right? but yes, that would be amazing. Please:

• don't be more certain in the content, than the underlying source is
• please watch out for too-close paraphrasing
• please keep the animal and cell studies out of it
• please avoid being too technical, and use wikilinks where it will help your average person (our Reader!) understand.
• please don't capitalize like you were writing in German. Thanks!! Jytdog (talk) 19:16, 31 March 2015 (UTC)

i want to compliment you on finding that absolute killer source. boy that is a great one. ALSO please consider WP:WEIGHT - the new content you added is gynormous - is it such an important aspect that it deserves all that space? Really, please think about WEIGHT and what is due and undue. i get the feeling that you are (?) (or are part of) a class, and one of the things we-who-remain struggle with, is class projects dramatically expanding one part of an article and leaving the whole thing distorted. So please do consider the whole. Thanks again! Jytdog (talk) 19:21, 31 March 2015 (UTC)

Review on extracorporeal treatment for poisoning

doi:10.2215/CJN.10021014 JFW | T@lk 10:27, 8 May 2015 (UTC)

Please remove and change this

"Lithium may cause problems in the baby if used during pregnancy." That sounds like a 5 year old made a sentence. — Preceding unsigned comment added by 98.177.199.12 (talk) 06:24, 22 December 2015 (UTC)

We tend to write the leads in simple English. Both well educated English speakers and less well educated or people who speak En as a single language can understand that sentence. Doc James (talk · contribs · email) 17:54, 22 December 2015 (UTC)

genetic variants

Bsaway - This dif introduced content very close to WP:COPYVIO, and based on a brand new primary source. Doc James kindly fixed the copyvio by paraphrasing, and then I removed this altogether, since it is based on a brand new primary source that may or may not hold up; we don't base content on primary sources like this per WP:MEDRS. I told you about the copyvio problem and the sourcing problem on your Talk page, here. You then restored your original content with all its problems in this dif. I again removed it and have provided you with an edit war warning here. If you don't understand why the content you introduced is not OK, please ask here, and do not edit war further. Thanks. Jytdog (talk) 20:06, 8 March 2016 (UTC)

interactions and overdose

Hello, A couple of my edits were just undone by Jytdog without any explanation that I can find. The offending sentences were: "Indeed there is evidence that even at therapeutic levels, lithium can cause neurotoxicity when used in combination with these and certain other antipsychotics, such as risperidone," under "Interactions", and "Symptoms of lithium neurotoxicity some times appear indistinguishable from Parkinsons disease," under "Overdose". Both statements had several citations to peer-reviewed medical articles which I thought provided adequate support. But I am new to editing wikipedia so perhaps I did something wrong? — Preceding unsigned comment added by Bobtheredeemer (talk • contribs) 07:30, 15 August 2016 (UTC)

Please do read the edit notes that others leave. They are all there in the history. Please do read WP:UNDUE, which is the policy I cited. Longer form - your edits are overloading the article with side effects. WP:WEIGHT is a really important aspect of the WP:NPOV policy. I know that looks like a lot of jargon but if you actually read those links it should make sense. Please let me know if it doesn't. thx Please also read WP:MEDRS - "peer reviewed" is not the criteria for sourcing health content. Peer reviewed review articles are what we use. Jytdog (talk) 07:34, 15 August 2016 (UTC)

Thanks for the response. I read your links. How about if I replace my Parkinson’s sentence with the following:

In addition to tremors, lithium treatment appears to be a risk factor for development of parkinsonism symptoms, although the causal mechanism remains unknown. A study of thousands of elderly patients found lithium use to be associated with increased prescription of medication for treatment of Parkinson’s disease.

References

The 1st citation is to a review article, as requested. The 2nd citation is to a cohort study, which is a primary source, but is arguably of a higher (less biased) level than my previous case studies, according to www.ciap.health.nsw.gov.au/education/learning/module4/section_3_7.html

I believe the above edit would meet the criteria for due weight. Bobtheredeemer (talk) 12:34, 15 August 2016 (UTC)

Zombies

The following discussion is closed. Please do not modify it. Subsequent comments should be made on the appropriate discussion page. No further edits should be made to this discussion.

---

I've heard it can make patients feel like zombies. Any source on this? Benjamin (talk) 15:15, 16 November 2017 (UTC)

Probably not. How does a zombie feel? What's the scientific definition of a zombie anyway? If there is such a thing. Yintan  15:53, 16 November 2017 (UTC)

I have heard of that for some antidepressents in general, I do not have a source. Yintan: feeling like a zombie is a common way to describe feelings of dissociation and cognition difficulties. — Preceding unsigned comment added by DancerEE (talk • contribs) 20:23, 17 November 2017 (UTC)

The discussion above is closed. Please do not modify it. Subsequent comments should be made on the appropriate discussion page. No further edits should be made to this discussion.

Is it not okay to use a talk page as a sort of to do list? I've seen to do lists on talk pages before. Benjamin (talk) 07:04, 18 November 2017 (UTC)

External links modified

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Primary source

This is based on a primary source "In 2014, it was proposed that lithium treatment produces a pharmacological effect by influencing calcium signaling from both external and internal pools of calcium, by simultaneously antagonizing NMDA receptors and inhibiting inositol monophosphatase (IMPase)."

Not sure it is notable. We already discuss the topic in the research section.

References

-- Doc James (talk · contribs · email) 22:48, 25 April 2018 (UTC)

It is a primary source. We don't use them per WP:MEDDEF. This IP editor is very likely self-citing. Jytdog (talk) 14:43, 4 May 2018 (UTC)

User:SarekOfVulcan IP is back already :-( Doc James (talk · contribs · email) 01:22, 6 June 2018 (UTC)

Argh. Someone else should take the next action, to be sure consensus is enforced properly. --SarekOfVulcan (talk) 17:21, 6 June 2018 (UTC)

User:SarekOfVulcan the IP hoper continues... Doc James (talk · contribs · email) 16:53, 26 July 2018 (UTC)

Requested move 28 January 2019

The following is a closed discussion of a requested move. Please do not modify it. Subsequent comments should be made in a new section on the talk page. Editors desiring to contest the closing decision should consider a move review after discussing it on the closer's talk page. No further edits should be made to this section.

The result of the move request was: Procedural close superseded by request below {{3x|p}}ery (talk) 23:08, 28 January 2019 (UTC)

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Lithium (medication) → ? – Lithium (medication) violates naming convention by using parentheses for a subtopic rather than as a disambiguation. Per WP:PARENDIS it would be the correct name for an article about a medication which happens to be named "Lithium" but is not actually Lithium. Possible new names include Medical uses of lithium, Lithium as medication, and probably many more. The important point is, no parentheses. FWIW,

• CaseInPoint moved it in 2013 from Lithium pharmacology with edit summary "Lithium pharmacology" refers specifically to the physiological action of the drug. This article is about lithium as a medication more broadly. May also consi...
• redirects include Lithium (drug), Lithium (medication), Lithium drug, Lithium in the treatment of mania, Lithium pharmacology, Lithium salt, Lithium salts, Lithium therapy, Lithium treatment, Pharmacological lithium jnestorius^(talk) 12:22, 28 January 2019 (UTC)
• Comment: I'm not convinced the current title is a problem, but there is a whole series of articles that are titled like this. If one is to be considered for renaming, then they should probably all be considered together. Others include at least Adrenocorticotropic hormone (medication), Epinephrine (medication), Estradiol (medication), Estrone sulfate (medication), Estetrol (medication), Estrogen (medication), Estriol (medication), Estrone (medication), Insulin (medication), Norepinephrine (medication), Pancreatic enzymes (medication), Progestogen (medication), and Testosterone (medication). -- Ed (Edgar181) 13:01, 28 January 2019 (UTC)
  • Done, thanks jnestorius^(talk) 13:55, 28 January 2019 (UTC)

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The above discussion is preserved as an archive of a requested move. Please do not modify it. Subsequent comments should be made in a new section on this talk page or in a move review. No further edits should be made to this section.

Requested move 28 January 2019

The following is a closed discussion of a requested move. Please do not modify it. Subsequent comments should be made in a new section on the talk page. Editors desiring to contest the closing decision should consider a move review after discussing it on the closer's talk page. No further edits should be made to this discussion.

The result of the move request was: Relisted below with additional added. If this is abuse of process then revert or whatever. ~~~~

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• Lithium (medication) → Lithium as medication
• Dopamine (medication) → Dopamine as medication
• Testosterone (medication) → Testosterone as medication
• Oxytocin (medication) → Oxytocin as medication
• Estradiol (medication) → Estradiol as medication
• Norepinephrine (medication) → Norepinephrine as medication
• Progesterone (medication) → Progesterone as medication
• Pancreatic enzymes (medication) → Pancreatic enzymes as medication
• Insulin (medication) → Insulin as medication
• Pregnenolone (medication) → Pregnenolone as medication
• Epinephrine (medication) → Epinephrine as medication
• Estrogen (medication) → Estrogen as medication
• Nitrous oxide (medication) → Nitrous oxide as medication
• Adrenocorticotropic hormone (medication) → Adrenocorticotropic hormone as medication
• Activated charcoal (medication) → Activated charcoal as medication
• Vasopressin (medication) → Vasopressin as medication
• Estriol (medication) → Estriol as medication
• Angiotensin II (medication) → Angiotensin II as medication
• Pulmonary surfactant (medication) → Pulmonary surfactant as medication
• Nitroglycerin (drug) → Nitroglycerin as medication
• Glucagon (medication) → Glucagon as medication
• Potassium permanganate (medical use) → Potassium permanganate as medication
• Factor VIII (medication) → Factor VIII as medication
• Estrone (medication) → Estrone as medication
• Estetrol (medication) → Estetrol as medication
• Estrone sulfate (medication) → Estrone sulfate as medication

– Foo (medication) is appropriate per WP:PARENDIS where Foo is an unrelated topic that happens to have the same name (e.g. Tarka (medication) no connection with any other Tarka), not where Foo is the parent topic and Foo (medication) is a refactoring of the Foo#As a medication section. For that we use descriptive phrases: Foo as medication, Medical uses of foo, etc. are all possible. jnestorius^(talk) 13:55, 28 January 2019 (UTC)

• Support Generally disambiguated topics are supposed to be totally different._{ZXCVBNM (TALK)} 15:57, 28 January 2019 (UTC)

• Oppose, the names and descriptor seem fine as is, and per brevity. Randy Kryn (talk) 21:57, 28 January 2019 (UTC)

• Support per nom. Subtopics do not use parenthetical disambiguators. Either "...as medication" or "Medical uses of..." are fine with me. —  AjaxSmack  00:08, 29 January 2019 (UTC)

• Oppose per Randy Kryn - || RuleTheWiki || (talk) 13:13, 29 January 2019 (UTC)
• Oppose Fine the way they are. The current names are short and clear. Doc James (talk · contribs · email) 01:56, 2 February 2019 (UTC)

The discussion above is closed. Please do not modify it. Subsequent comments should be made on the appropriate discussion page. No further edits should be made to this discussion.

Discussion

I would like to relist with these added but I don't knw how the bot will take it:- |current27=Alcohol (medicine) |new27=Alcohol as medication |current28=Magnesium (medical use) |new28=Magnesium as medication |current29=Zinc sulfate (medical use) |new29=Zinc sulfate as medication |current30=Magnesium sulfate (medical use) |new30=Magnesium sulfate as medication |current31=Iodine (medical use) |new31=Iodine as medication |current32=Potassium chloride (medical use) |new32=Potassium chloride as medication |current33=Prussian blue (medical use) |new33=Prussian blue as medication |current34=Acetic acid (medical use) |new34=Acetic acid as medication |current35=Sodium thiosulfate (medical use) |new35=Sodium thiosulfate as medication |current36=Sodium nitrite (medical use) |new36=Sodium nitrite as medication |current37=Fluorescein (medical use) |new37=Fluorescein as medication

• Oppose Fine the way they are. The current names are short and clear. Doc James (talk · contribs · email) 01:56, 2 February 2019 (UTC)

Requested move 29 January 2019

The following is a closed discussion of a requested move. Please do not modify it. Subsequent comments should be made in a new section on the talk page. Editors desiring to contest the closing decision should consider a move review after discussing it on the closer's talk page. No further edits should be made to this section.

The result of the move request was: Not moved. No consensus to move. (non-admin closure)  samee  converse  14:51, 12 February 2019 (UTC)

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• Lithium (medication) → Lithium as medication
• Dopamine (medication) → Dopamine as medication
• Testosterone (medication) → Testosterone as medication
• Oxytocin (medication) → Oxytocin as medication
• Estradiol (medication) → Estradiol as medication
• Norepinephrine (medication) → Norepinephrine as medication
• Progesterone (medication) → Progesterone as medication
• Pancreatic enzymes (medication) → Pancreatic enzymes as medication
• Insulin (medication) → Insulin as medication
• Pregnenolone (medication) → Pregnenolone as medication
• Epinephrine (medication) → Epinephrine as medication
• Estrogen (medication) → Estrogen as medication
• Nitrous oxide (medication) → Nitrous oxide as medication
• Adrenocorticotropic hormone (medication) → Adrenocorticotropic hormone as medication
• Activated charcoal (medication) → Activated charcoal as medication
• Vasopressin (medication) → Vasopressin as medication
• Estriol (medication) → Estriol as medication
• Angiotensin II (medication) → Angiotensin II as medication
• Pulmonary surfactant (medication) → Pulmonary surfactant as medication
• Nitroglycerin (drug) → Nitroglycerin as medication
• Glucagon (medication) → Glucagon as medication
• Potassium permanganate (medical use) → Potassium permanganate as medication
• Factor VIII (medication) → Factor VIII as medication
• Estrone (medication) → Estrone as medication
• Estetrol (medication) → Estetrol as medication
• Estrone sulfate (medication) → Estrone sulfate as medication
• Alcohol (medicine) → Alcohol as medication
• Magnesium (medical use) → Magnesium as medication
• Zinc sulfate (medical use) → Zinc sulfate as medication
• Magnesium sulfate (medical use) → Magnesium sulfate as medication
• Iodine (medical use) → Iodine as medication
• Potassium chloride (medical use) → Potassium chloride as medication
• Prussian blue (medical use) → Prussian blue as medication
• Acetic acid (medical use) → Acetic acid as medication
• Sodium thiosulfate (medical use) → Sodium thiosulfate as medication
• Sodium nitrite (medical use) → Sodium nitrite as medication
• Fluorescein (medical use) → Fluorescein as medication

– Foo (medication) is appropriate per WP:PARENDIS where Foo is an unrelated topic that happens to have the same name (e.g. Tarka (medication) no connection with any other Tarka), not where Foo is the parent topic and Foo (medication) is a refactoring of the Foo#As a medication section. For that we use descriptive phrases: Foo as medication, Medical uses of foo, etc. are all possible. [Relisted with Foo (medical use)" titles added] jnestorius^(talk) 14:04, 29 January 2019 (UTC) --Relisting. SITH (talk) 14:27, 5 February 2019 (UTC)

• Support Generally disambiguated topics are supposed to be totally different._{ZXCVBNM (TALK)} 15:57, 28 January 2019 (UTC)

• Oppose, the names and descriptor seem fine as is, and per brevity. Randy Kryn (talk) 21:57, 28 January 2019 (UTC)

Per brevity? But brevity is the bad misconception of concise. Why do you think brevity is good per se? —SmokeyJoe (talk) 22:54, 29 January 2019 (UTC)

per WP:CONCISE as well. Titles: "The title is no longer than necessary to identify the article's subject and distinguish it from other subjects". No need to make a sentence fragment out of this when a one-word descriptor has worked fine so far. Randy Kryn (talk) 11:15, 30 January 2019 (UTC)

Concision/concise is about information density, brevity allows for cutting information. I hope there is not a serious desire for density.

True, concision is decreased, Lithium (medication) --> Lithium as medication adds one character for the same information. However, I think there is such a thing as "sufficiently concise", which both are.

The one word descriptor is not being changed. So this is simply about NATURAL vs PARENTHETICAL, with the guideline preferring NATURAL, at a 1 character cost of length increase. I think the only question is whether the term / "sentence fragment" is natural (the other meaning). Do sources use the phrase "Lithium as medication"?

Do sources use the phrase "Lithium as medication"? Actually, not much. And when this phrase is used, it is not used as a term. "Sentence fragment" appears more apt, it is not even a phrase. Top google hits for "Lithium as medication" include: "taking low levels on lithium as medication"; "Not only is taking lithium as medication dangerous"; "Lithium, as medication, has been a benchmark of my life"; "this kind of lithium as medication"; "taking low levels of lithium as medication". I don't know the linguistic terminology, but these sentences are not referring to a topic "lithium as medication". Also noting that "lithium as medication" has zero Google Books hits.

"https://www.google.com/search?rlz=1C1GCEA_enAU792AU792&ei=r4pRXPijJ8TJrQHo172ABw&q=%22Lithium+medication%22&oq=%22Lithium+medication%22&gs_l=psy-ab.3..0i7i30j0j0i7i30j0j0i7i30j0i67j0j0i7i30j0j0i7i30.375392.376166..377337...0.0..0.167.475.0j3......0....1..gws-wiz.KLKV8iStlZY "Lithium medication" actually does better. It has google books ngram results and Ghits return its use as a term: "Lithium medications are used to treat and possibly prevent episodes of mania"; "Lithium medication is still the most researched and proven treatment for bipolar disorder"; "lithium medication can be a"; "Lithium medication was less common "; "lithium medication has been provided without blood test data"; "their lithium medication when they become pregnant"; "during periods of lithium medication".

I guess I am reviewing my !vote, the proposed is not so natural. --SmokeyJoe (talk) 11:45, 30 January 2019 (UTC)

@Randy Kryn:, @SmokeyJoe: I'm not wedded to the Foo as medication format; just some reworking that eliminates parentheses. The lack of ghits for "Foo as medication" is a straw man, since it is a description rather than a name. I don't think minimising the number of characters is a criterion; and if it were, Medical foo is shorter than Foo (medication). We have Adolf Hitler in popular culture, not Hitler (pop culture). jnestorius^(talk) 17:08, 30 January 2019 (UTC)

• Support per nom. Subtopics do not use parenthetical disambiguators. Either "...as medication" or "Medical uses of..." are fine with me. —  AjaxSmack  00:08, 29 January 2019 (UTC)
• Oppose per Randy Kryn - || RuleTheWiki || (talk) 13:13, 29 January 2019 (UTC)
• Oppose - I get why some may prefer the changes, but the current method is consistent with how we do (other use) types of pages at wikipedia. The change doesn't really solve any navigational problems that I can see, so I would say to keep it more brief and to the point. Dennis Brown - 2¢ 17:02, 29 January 2019 (UTC)
  • @Dennis Brown: "how we do (other use) types of pages at wikipedia": apologies, I don't understand what an "(other use) type of page" is. Could you give some examples? jnestorius^(talk) 22:12, 29 January 2019 (UTC)
• Oppose per Randy and Dennis. Seppi333 (Insert 2¢) 18:55, 29 January 2019 (UTC)
• Support per WP:NATURALDISAMBIGUATION. Parenthetical disambiguators should only be used as a last resort. Rreagan007 (talk) 20:15, 29 January 2019 (UTC)
• Support for Lithium for sure. It’s the same lithium, it is not a different lithium as parenthetical disambiguation implies. A straightforward case of WP:NATURAL. The others are probably the same, but I haven’t looked into them. —SmokeyJoe (talk) 22:53, 29 January 2019 (UTC)

I think these are examples of how Wikipedia has taken its love of the parenthetical to an extreme. —SmokeyJoe (talk) 22:56, 29 January 2019 (UTC)

Oppose. in favour of Lithium medication. Checking out uses, I am seeing that "Lithium as medication" is not used as a term describing something. It occurs as a string, but always in connecting different parts of the sentence. In contrast, Lithium medication is a naturally used term. --SmokeyJoe (talk) 11:48, 30 January 2019 (UTC)

Oppose. Not convinced that any change is a good idea. --SmokeyJoe (talk) 02:10, 2 February 2019 (UTC)

• Support a simple and commonsense change that makes the titles much easier to read and closer to lay English. We don't have space constraints here so I don't see a compelling need for parentheses. --Tom (LT) (talk) 01:13, 30 January 2019 (UTC)
• Support per Ajax. Either "...as medication" or "Medical uses of..." are fine with me. Srnec (talk) 16:55, 30 January 2019 (UTC)
• Oppose per WP:COMMONNAME plus WP:D, including WP:NATURAL. I get the impetus here, and I was going to support, but then I thought... the commonly used name for each of these is just the basename, like Lithium. I presume we all agree with that? I mean, the doctor says, "I'm going to write you a prescription for Lithium", right? Not, "I'm going to write you a prescription for Lithium as medication", or even "I'm going to write you a prescription for Lithium medication". And what that suggests to me is that neither "Lithium as medication" nor "Lithium medication" qualify as NATURAL disambiguations which are defined as "an alternative name that the subject is also commonly called in English reliable sources, albeit not as commonly as the preferred-but-ambiguous title". The ngrams for Lithium vs. Lithium medication vs. Lithium as medication show that it's an enormous stretch to claim that the topic here is also commonly called "Lithium medication". So, I think we have to go with parenthetic disambiguation in this case, and I don't think there is any disagreement that the current titles are the best choices for that. I also think the argument that the proposed "as" titles should be accepted as descriptive titles here is very weak. Generally, we use descriptive titles for topics that don't have names. The classic example is any "List of ..." title, but there are many others. We generally don't use descriptive titles for articles with topics that have names, but require disambiguation. --В²C ☎ 01:53, 1 February 2019 (UTC)
  • @Born2cycle: — the point is that this is not a disambiguation, natural or otherwise; it's a subtopic. Paris in World War II was not called "Paris in World War II", it was called "Paris" during World War II, and in modern books about World War II it is called "Paris". But it doesn't need to be disambiguated from Paris, because it is not a separate entity with the same name; it is rather a subtopic of the same Paris. Hence the article is not called Paris (World War II). jnestorius^(talk) 09:52, 1 February 2019 (UTC)
    • I get that’s the intent. I disagree the two are comparable. The topic there is time-bound, and that needs to be reflected in the title. It’s about what Paris was like in WWII. It was called Paris then, but today that topic - Paris in WWII - is not known as Paris. But here we have a topic that is most commonly known as Lithium today. It needs to be disambiguated. And it is. —В²C ☎ 17:03, 1 February 2019 (UTC)
    • Is Lithium (medication) the same topic as Lithium or is it a different lithium? Peter James (talk) 20:00, 10 February 2019 (UTC)
• Oppose Fine the way they are. The current names are short and clear. Doc James (talk · contribs · email) 01:57, 2 February 2019 (UTC)
• Support. The current title is not fine, it should be clear even if the parentheses is removed. There is no need to see the usage in the reliable source because this article is an extension of Lithium#Medicine per WP:SUMMARYSTYLE. Hddty. (talk) 04:07, 5 February 2019 (UTC)
• Oppose The article names are, in my opinion, more concisely described the way they are currently and easier to read. No need to rename them to a longer name that does not make the title any more descriptive in nature. {{u|waddie96}} {talk} 10:47, 5 February 2019 (UTC)
• Support per WP:NATURALDIS policy, and for WP:CONSISTENCY with similar cases.  — SMcCandlish ☏ ¢ 😼  01:38, 8 February 2019 (UTC)
• Oppose Consistency and simplicity are the guides that inform the structure of page titles. Specifically Wikipedia has a standard preference for disambiguation titles:-

Parenthetical disambiguation, i.e. adding a disambiguating term in parentheses after the ambiguous name: Wikipedia's standard disambiguation technique when none of the other solutions lead to an optimal article title.

   Example: The word "mercury" has distinct meanings that do not have sufficiently common alternative names, so we instead use parenthetical disambiguation: Mercury (element), Mercury (mythology), and Mercury (planet).

Descriptive title: where there is no acceptable set name for a topic, such that a title of our own conception is necessary, more latitude is allowed to form descriptive and unique titles.

   Examples: List of birds of Nicaragua, Campaign history of the Roman military, Pontius Pilate's wife (see WP:NCP#Descriptive titles)

In addition, a circumstance may exist where any of the listed Main Titles are requiring disambiguation in circumstances not given to expression in any sort of consistent expressive grammar. e.g. Lithium (Controversy). The lack of a current controversy should not prevent the provision of a pattern or policy that provides for future necessary 'disambiguable' pages in a consistent manner. For the above reasons I oppose departing from the use of parentheses as a means of title disambiguation. Bilbo-2014 (talk) 22:28, 8 February 2019 (UTC)

• If the verdict is "yes", someone will have to move 37 pages. Anthony Appleyard (talk) 08:18, 9 February 2019 (UTC)
• Oppose. Medgirl131 04:25, 10 February 2019 (UTC)
• Support for any that are about the same thing - if they have the same external identifiers either merge the articles or make it clear that they are subtopics. Peter James (talk) 20:00, 10 February 2019 (UTC)
• Oppose No good reason for the move and the new forms would break use of the pipe trick. Andy Dingley (talk) 22:47, 10 February 2019 (UTC)

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The above discussion is preserved as an archive of a requested move. Please do not modify it. Subsequent comments should be made in a new section on this talk page or in a move review. No further edits should be made to this section.