Ronald R Fieve

Ronald R Fieve

Dr. Ronald R Fieve was born in Stevens Point, Wisconsin on March 5, 1930 and died of congestive heart failure in Palm Beach, Florida on January 2, 2018. He became a member of American College of Neuropsycopharmacology (ACNP) in 1969.

Ron completed medical school at Harvard University, interned in cardiology at Bellevue Hospital, and did his psychiatric training at Columbia University College of Physicians and Surgeons and the New York State Psychiatric Institute (PI). While a resident at PI, he was asked to study the effects of lithium carbonate as a treatment for manic depressive disorder (now known as bipolar disorder). He subsequently joined the psychiatric faculty at Columbia/PI and was director of the Department of Internal Medicine at that facility, where he supervised the employee health clinic as well as an in-patient metabolic research unit. His early work regarding lithium involved studies of treatment of acute mania and acute depression. In addition, he was involved in studies of the effects of lithium treatment on electrolyte metabolism. As his research and clinical efforts in using lithium carbonate to treat bipolar disorder expanded, he developed the “Lithium Clinic” at PI for the study of maintenance effects of lithium in attenuating future episodes of bipolar depression and mania in outpatients. He organized one of the pivotal double-blind, placebo controlled trials of lithium carbonate for maintenance treatment of bipolar disorder, and this trial was important in the Food and Drug Administration’s approval of lithium maintenance treatment for this condition in the early 1970s.

The world of psychiatry has changed markedly in the past 50 years. Prior to the demonstration that long-term treatment with lithium carbonate could have maintenance effects in bipolar disorder, acute mania was treated with antipsychotic medications (chlorpromazine, thioridazine) and perhaps electroconvulsive therapy (ECT). Bipolar depression was treated with tricyclic antidepressants, perhaps monoamine oxidase inhibitors, and perhaps ECT. Patients who experienced recurrences of their disorder were usually rehospitalized and treated without provision for long-term treatment. Psychopharmacology generally was not emphasized in most psychiatry residency training programs in comparison to psychotherapy. Mania was poorly diagnosed in the United States as compared with the diagnosis in England—most patients who experienced psychotic symptoms in the United States were diagnosed as having schizophrenia. Lithium salts, which had been tried in the United States in the 1940s as a substitute for sodium chloride for cardiac patients, were found to be toxic.

The “Psychopharm Revolution” resulted from a change in diagnostic classification to force clinicians in the United States to increase their recognition of mania (Diagnostic and Statistical Manual of Mental Disorders, Third Edition), research studies demonstrating the efficacy and safety of lithium carbonate treatment for acute mania, acute bipolar depression, and for prevention of recurrence of mania and depressive episodes among bipolar patients, the establishment of “Lithium Clinics” or “Mood Disorder” clinics in major academic medical centers, increased emphasis of psychopharmacological treatments being taught in psychiatry residency programs, and even participation of patient advocates to help reduce the stigma of mood disorders. Ron played an important role in this process. He produced the relevant research, developed the appropriate treatment model, and was a frequent public advocate for lithium carbonate treatment. His many books are written to educate the public about bipolar disorder.

Later in his career, Ron established the “Lithium Archive Project,” which involved the collection of data from the many thousands of patients Ron had treated. Early findings from this project, which have been presented at posters at the last several ACNP meetings, suggest that long-term lithium treatment may have a effect in reducing the development of central nervous system disorders such as Alzheimers.

I joined Ron’s group in 1971 and left in 1979. He was exciting to work with, creative in his endeavors, and supportive of my research efforts. I still refer patients to his books for information regarding bipolar disorders.

Director, Center for Anxiety and Depression