lithium

Lithium is a chemical element that is widespread in nature. You can find it in the earth’s crust, in water and even in the food you eat. Depending upon where you live, there is a good chance that there are trace amounts of lithium in your drinking water. Could this mineral be beneficial for the brain?

From Batteries to the Brain:

Most people these days are aware of lithium-ion batteries. They power our cell phones, laptop computers and other portable electronic devices. Heart pacemakers are powered by lithium-containing batteries. Electric vehicles, including the high-end Teslas, run on lithium-ion batteries as well.

Lithium for Bipolar Disorder:

It’s quite a jump from batteries that power computers or cars to medicine. Physicians began using this element in the mid-nineteenth century. A British internist, Dr. Alfred Baring Garrod, figured out that gout was caused by elevated uric acid levels in the body. He used lithium to lower uric acid and ease the symptoms of gout, including something he called “brain gout” (Bipolar Disorders, June, 2009).

Lithium for Bipolar Disorder:

Psychiatrists and neurologists began using lithium salts to control seizures and calm nervous patients in the 1870s. In 1871, Dr. William Hammond of the Bellevue Hospital Medical College in NYC wrote in his book, A Treatise on Diseases of the Nervous System:

“Latterly I have used the bromide of lithium in cases of acute mania, and have more reason to be satisfied with it than with any other medicine calculated to diminish the amount of blood in the cerebral vessels, and to calm any nervous excitement that may be present.”

Within a decade or two Danish physicians began using lithium carbonate for depression.

“Crazy Water” in Mineral Wells, Texas:

The town of Mineral Wells, Texas, developed a reputation for its unique water. According to legend, a “crazy old lady” would regularly drink the well water in town. Gradually, her dementia seemed to lift and she had less of the “crazies.” Soon, people from all over the country were flocking to Mineral Wells to drink from the “Crazy Well.”

By 1909 there were seven wells, four bath houses featuring the mineral water and nearly 50 boarding houses or hotels. Some of the wells in Mineral Wells had measurable amounts of lithium. The Crazy Water Company continues to this day and lists lithium as one of the minerals in its Crazy Water #4.

Hangover Remedy?

During the early part of the 20th century lithium was sold as a patent medicine to treat hangovers and other health concerns. In 1929, Bib-Label Lithiated Lemon-Lime Soda was a new soft drink. The marketing slogan was: “It takes the ouch out of the grouch.” The product became 7 Up Lithiated Lemon Soda and was eventually renamed 7 Up, presumably for the atomic weight of lithium (6.9). After 1950, however, the lithium was removed.

The Resurgence of Lithium:

For most of the early twentieth century, the medical community lost interest in lithium. It might have remained forgotten had it not been for an Australian physician who reported that lithium citrate and lithium carbonate could relieve “psychotic excitement” (Medical Journal of Australia, Sept. 3, 1949). Other Australian researchers reported that this element was helpful against what was then called mania (Medical Journal of Australia, Aug. 18, 2951).

United States Lags in Lithium:

For reasons that remain somewhat mysterious, American physicians were extremely slow to adopt lithium therapy. Denmark, Britain, France, Germany and many other countries approved the use of lithium for patients with depression and mania. By the time the FDA gave it the green light in 1970, fifty other countries had approved it for the treatment of manic depression.

Bipolar Disorder:

Most health professionals now refer to manic depression as bipolar disorder. Lithium is considered a key treatment. Because the dose of lithium used to treat this condition is very high, patients and their families are warned to be alert for symptoms of toxicity such as diarrhea, vomiting, trouble walking, muscle weakness or drowsiness.

Lithium can also reduce kidney function. Patients should be monitored for that potential adverse effect. Thyroid function should also be monitored, since chronic lithium can impair the thyroid gland (Environmental Health Perspectives, June 2011).

Lithium Side Effects:

  • Hand tremor
  • Thirst, dry mouth
  • Frequent urination
  • Digestive distress, nausea, vomiting, loss of appetite, diarrhea
  • Weight gain

Signs of Lithium Toxicity:

  • Drowsiness, fatigue, lethargy, cognitive dysfunction
  • Muscle weakness
  • Coordination problems
  • Giddiness, unsteadiness walking difficulties
  • Blurred vision
  • Ringing in the ears
  • Excessive urination
  • Muscle twitching (fasciculations), uncontrollable muscle movements
  • Slurred speech, blackouts, seizures, vertigo, confusion
  • Incontinence
  • Irregular heart rhythms, low blood pressure
  • Kidney damage
  • Thinning hair, hair loss
  • Acne
  • Thyroid disorders (goiter, hypothyroidism)
  • Diabetes insipidus

Drug Interactions with Lithium-Containing Meds:

There are a great many medications that can interact dangerously with lithium. They include:

  • Amiloride
  • Benazepril
  • Captopril
  • Chlorothiazide
  • Chlorpromazine
  • Chlorthalidone
  • Desmopressin
  • Diltiazem
  • Enalapril
  • Fluphenazine
  • Fosinopril
  • Furosemide
  • Hydrochlorothiazide
  • Indapamide
  • Lisinopril
  • Losartan
  • Moexipril
  • Promethazine
  • Ramipril
  • Spironolactone
  • Trandolapril
  • Triamterene
  • Valsartan
  • Verapamil

This is not a complete list. Always check with your pharmacist about all potential drug interactions!

Low-Dose Lithium: A Different Ballgame

Many of the very serious adverse reactions mentioned above are associated with the high doses of lithium that have been approved by the Food and Drug Administration. The agency has not considered low-dose therapy.

Despite the long list of side effects and drug interactions, low-dose lithium is an idea that is starting to resurface. A fascinating article in the New York Times (Sept. 13, 2014) was titled:

“Should We All Take a Bit of Lithium?”

It was written by Dr. Anna Fels, a psychiatrist and faculty member at Weill Cornell Medical College. Dr. Fels pointed out in her article that:

“…people whose water had the least amount of lithium had significantly greater levels of suicide, homicide and rape than the people whose water had the higher levels of lithium. The group whose water had the highest lithium level had nearly 40 percent fewer suicides than that with the lowest lithium level.

“Almost 20 years later, a Japanese study that looked at 18 municipalities with more than a million inhabitants over a five-year period confirmed the earlier study’s finding: Suicide rates were inversely correlated with the lithium content in the local water supply.

“More recently, there have been corroborating studies in Greece and Austria.”

The idea that low doses of lithium might be linked to less depression and suicide is intriguing. There is even some evidence that it might be neuroprotective. Dr. Fels goes on to suggest that:

“…its efficacy in mood disorders and suicide prevention has been documented as well as or better than virtually any other psychotropic medication. But it retains a grim and undeserved reputation, perhaps because it was originally associated in the public mind with serious mental illness and because, like many medications, lithium can have serious side effects if not monitored properly. As a psychiatrist, I can tell you that because of its stigma, lithium as a medication is a hard sell to patients with serious mood disorders who could clearly benefit from treatment. But there are undoubtedly other reasons for its neglect. Pharmaceutical companies have nothing to gain from this cheap, ubiquitous element.”

OTC Lithium?

Lithium is available as a dietary supplement, and people are taking it. Researchers have reported that lithium, zinc or magnesium at nutritional levels may help ease anxiety or depression (Pharmacological Reports, Aug. 2014).  Lithium supplementation (at a dose of 400 micrograms) improved energy, friendliness and happiness in a very small placebo-controlled study with former drug users (Biological Trace Element Research, Jan. 1994).

That helps explain the renewed interest in this compound as a dietary supplement. Who wouldn’t want to increase their happiness, however that might be measured?

As Dr. Fels wrote, some studies of lithium levels in drinking water suggest that suicide rates are lower where natural levels of lithium are higher (International Journal of Environmental Research and Public Health, Nov. 12, 2013; International Clinical Psychopharmacology, Jan. 2015).

Is Lithium Helpful for Depression?

Some psychiatrists are now prescribing lithium orotate or lithium citrate at low doses (10 or 20 mg) for depression. In fact, certain psychiatrists believe that it can be helpful, after electroconvulsive therapy, for treatment-resistant depression (Revue Medicale de Bruxelles, 2017). To put the low dose of 10 to 20 mg into perspective, you have to realize that the official FDA prescribing information lists doses of lithium carbonate in range of 900 to 1,200 mg daily.

What About ADHD?

Dr. James Greenblatt reports that very low dose lithium can be helpful for children with attention difficulties, especially those for whom irritability, anger and aggression are an important part of the picture (Greenblatt & Gottlieb, Finally Focused, Harmony Books, 2017).

Parents who would like to try such an approach for their children should discuss this possibility with the pediatrician first. They may also wish to consult ConsumerLab.com for the results of tests on lithium orotate supplements the organization will be conducting later this year. (There is a charge for an annual subscription to ConsumerLab.com to access their full reports.)

Your Thoughts?

We welcome your thoughts about low-dose lithium. If you have ever used this approach, please share your experience. If you have experienced toxicity from this mineral, we would like to hear your story in the comment section below. Thank you for sharing and voting on this article at the top of the page.

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  1. Maree
    Melbourne, AUSTRALIA
    Reply

    The people who i know who have been on lithium have all gained weight. That, in itself, would make ME depressed

  2. Linda
    seattle Wa
    Reply

    Lithium saved my bipolar sister after years of mania and crazy behavoir that nothing else helped. My father would probably still be here today if he had been correctly diagnosed. Lithium brought me back to sanity after 9 months of mania that ended in crisis before I got help. My levels were monitored and I wonder if the people with negative comments were. I can’t help but think a natural remedy is so much better than psyhcoactive drugs such as Thorazine. The low dosage therapy sound like the answer.

  3. Linda
    Reply

    Nothing was helping my sister come off her mania and crazy behavoir until she was prescribed lithium. If my father had gotten a correct diagnosis, and lithium, he probably would be here today. Lithium totally helped me retrieve my sanity from mania and I am grateful to this day and resent the negative comments I just read. My son is having mania and is resisting what helped his other family members.

  4. Joe B
    Norwell
    Reply

    I took 10 mg lithium orotate for approximately 3 weeks I just felt like everything had slowed down however my sex drive was completely eliminated where it was more than healthy before adding the lithium orotate.

  5. Cindy M. B
    Reply

    During 30+ years working in the mental health system, I came to equate lithium with severe weight gain, pocky-pasty-waxy skin, tremors (some of which never went away even after d/c’ing the lithium), and changes in dosages/efficacy for any given patient, i.e., it stops working after awhile. Maybe the dosages were too high to begin with (as per your article), but to my mind, lithium is just a nasty, nasty drug. Of course it does help some people, but the first thing I’d always ask a patient is how they thought their medication was helping them. I can remember very few enthusiastic endorsements.

    • Ron
      Seattle, WA
      Reply

      Cindy hit the nail on the head about side effects listed in your article. I would not give an enthusiastic endorsement, but it did the job controlling my mania for many years. I second the notion that lithium is a nasty (unpleasant) drug, but I suspect that most drugs to control mania are not without problems. After 25 years of taking various ones, I have yet to experience one that was not without some significant problems.

  6. Ron
    Seattle, WA
    Reply

    I had taken about 1000mg/day Lithium for more than 5 years to control mania to good effect. I experienced the all of the side effects listed above except the digestive issues. I gradually had more hand tremors over time to the point I was unable to sign my name. At that point I discontinued using it and went on to other mood stabilizing drugs. After many years I needed to use Lithium for a short period and the hand tremors were as bad as when I originally stopped using it. In the last 6 months, I have been using 5mg/day lithium and seem to have a subtle increase in mood/happiness. Nasty experiences do not seem to bother me as much as before. I might be more mellow.

  7. Ellen
    Reply

    I wonder if low-dose lithium might be helpful toward preventing dementia and Alzheimer’s…

  8. Tania
    Reply

    In the early 2000’s I was prescribed lithium for bipolar disorder. Strangely I dont recall if it helped w/ mainly the depression aspect but I do remember gaining 30lbs in about 15 months!! No thank you!

  9. Mel
    CT
    Reply

    I took lithium for bipolar depression at a pretty high dose and it made my hair fall out. Very stressful for a female who has always had thick, long hair. I also did not feel any benefit from the medication. Had to discontinue it.

  10. Elizabeth
    Maine
    Reply

    on lithium for 23 years until host of awful neuro symptoms finally diagnosed by neurologist as chronic toxicity. Symptoms started a few months into treatment and got steadily worse until very screwed. None of my many docs caught it. Serum levels were always ok but diagnosing doc said cells were saturated Titrated off over 4 months feeling consistently better. When first put on Lithium in 1994, depression was dramatically alleviated, but returned over the years with a vengeance, almost constant suicidal ideation plus grave ataxia, seizure-like uncontrollable locomotion, migraines 6-20 a month, confusion, memory issues.

    All lifted once off. then mold tox put me back in the tarpit physically. Still many neuro symptoms … mold toxicity and related problems or lingering lithium tox 8 months after off completely? Sucks but neither manic nor depressed and not on any mood stabilizer, just wellbutrin. Physical stuff a cakewalk compared to dark days of depression. Hoping for eventual remission of muscle weakness, adrenal splat, very low blood pressure etc as mold clears and maybe after effects of chronic lithium toxicity dissipate.

  11. John
    Wisconsin
    Reply

    I just went to CVS, Walgreens, and an independent pharmacy. They all acted like I was crazy asking for Lithium. They said there is no OTC available and said I must have heard the wrong name. I asked if they knew of the People’s Pharmacy on NPR. They all said no and one asked if the show was coming from a foreign country. I looked at a bunch of “brain health” supplements on the shelves and none had lithium. I would prefer to not have to buy something on-line. Any advice?

  12. Lise
    Virginia
    Reply

    This is a very interesting topic. I have a low thyroid condition,and have heard of someone taking lithium. Their hair fell out as with any drug it needs to be monitored. I’m just wondering if any OTC. Drugs contain lithium.

  13. Mag
    Seattle, WA
    Reply

    I am so happy to see someone talking about Lithium – the greatly under-rated, wonderful
    thing that saved me 40 years ago. That’s how long I have been taking it. I was a mess.
    Couldn’t stop crying (the doctor said it was not from depression – rather it was from the exhaustion of going full speed ahead for so long. I was wonder woman. I had four kids, worked fulltime, volunteered, lobbied for special needs kids, and loved it all. And then I crashed.

    Thank Heavens, I was fortunate enough to find a neurologist who had heard of Lithium and had me try it. I found him on my fourth try. The first three wanted me to sit “and talk about it.”
    I was overdosed at first – I think the starting doses of 900-1200mgs are much too high unless someone is a threat to themselves or others. I was not. I took 150mgs for 20 years, then when my thyroid tanked we had to play with the dose and now I take 300. I have never missed a dose and I’ve never had a relapse.

    To be sure, there are a few downsides. For the first year I felt as though I was moving in slow motion and that someone had chopped 20 points off my IQ. I hated it. I don’t know if I got used to feeling stupid or ??? but at 74 I’m pretty high functioning and still do all the things I’ve always done. I still work, can learn new things, ski, play my guitar and take care of great-grandkids.

    One thing about Lithium is you can’t go off and on it. When my thyroid trouble started, my lithium level dropped. (I’m perfect at .3 or .4 although doctors have told me that’s a non-therapeutic dose. I say “Oh yea? How about I stop taking it for a couple of days and come back and see you?” Then I don’t go back to that narrow minded doctor.) I switched to Depakote, but that bothered my eyes, so I went back on the lithium for the last 20 years but had to double the dose. Sometimes it won’t even work on a second try. No more experimenting for me. I don’t ever want to have to take any of the other antidepressants that so many of my friends are struggling with. God bless Dr Cade for giving us this life saving option, and thanks to the Peoples Pharmacy for their article shedding light on it.

  14. Ann
    Nc
    Reply

    You say it has neither a helpful purpose, nor do you recognize side effects? Basically, you feel nothing from this element on a ‘regular basis’??? Huh?

  15. Marie
    Indiana
    Reply

    I am bipolar and take a relatively low dose of lithium (150 mg) as PART of my treatment. My regimen is a mood stabilizer (lamotrigine) and an antidepressant (escitalopram) and am generally well controlled. However, the transitions from autumn to winter can send me very low and the transition from winter to spring can send me very high. Adding antidepressants made me more anxious but still depressed, and adding anxiolytics made me uselessly passive.

    The low dose lithium seems to prop up my other meds and smooth out these rough spots. I am not seeing any changes in blood work or weight gain and it has taken away the dread I used to feel at the changing seasons. I use it from ~Oct to ~April (I live in the southern US) and sometimes even add it in at times of great stress at other times. It’s a nice med that doesn’t really need to be stepped down or up at these levels. The first time you take it you may feel tired for a day or two, like walking through mud, but that lifts pretty quickly.

    [Lithium was a wonder drug for my grandfather’s generation, something that allowed him to function and work and care for his family and live a long life as his father had not been able to. That was his only med, I think, but probably at a much higher dose.]

  16. Cindy
    FL
    Reply

    Be very careful with dosages of lithium and the length of time you take it for bipolar disorder. After 28 years of taking it I have chronic kidney disease that is gradually advancing. It is the “gold standard” for treating BPD, and did help me, but one needs to measure the pros and cons.

  17. Mary
    Reply

    I do take lithium orotate or lithium aspartate pretty regularly. They only have 5 mg of lithium and easily available online.
    Benefits? Hard to say. No side effects either.

  18. Grace
    Reply

    The article on lithium is so needed. Lithium as a natural mineral in a natural water supplies is unknown to many people . But well known psychiatrists w bipolaritywrote of its benefits for many. Baring the side effects of higher dosing , a good segment of population would benefit otc doses or natural water sources. I’m an older Licensed psychotherapist who saw the. benefits on bipolar patients who did not respond enough or well to the other meds used . Actually, severe cases were most often given lithium first ( never mind the high dose side effects ) initially because it worked ! Thank you for this article !

  19. Rick
    Reply

    Lithium is not the answer if you are hypothyroid and many people that are hypothyroid are bipolar. I would say that the danger s of lithium far outweigh the advantages. Lithium apparently increases the amount of serotonin in the brain too much serotonin causes serotonin syndrome and that can be deadly as it causes suicidal and homicidal tendencies as can be seen with the use of tramadol for pain. From personal experiences, no thank you.

  20. Chuck
    Reply

    Dr. Jonathan Wright, a well-known and highly respected alternative physician who has a sizable clinic in Tacoma Washington has been a proponent of low-dose lithium usage, lithium orotate or lithium citrate, for many years.

    His reasoning as I recall was that it provides some degree of brain protection. I have been taking this for years and have noticed absolutely no side effects and hopefully it has provided protection. The first time I went into a health food store to purchase this the attendant looked at me as if I were a nutcase. This used to be typical and I’m not sure if it still is or not.

  21. dj
    Michigan
    Reply

    What about the lithium that occurs naturally in some bottled mineral waters? Are those small amounts of any benefit if drunk on a regular basis?

  22. Cathie
    Cary, NC
    Reply

    Well, I am ready to give a lithium supplement a try for a couple of months. Why not increase my happiness level?!

  23. Bev
    Tasmania, Australia
    Reply

    Hi, I am a 77 year old who is taking lithium as a mood stabler with nortriptilyne. I have only been on the lithium 5 weeks and so far not much improvement. I was very interested in your chapter on Lithium, and I am more positive of the future. Many thanks Bev

  24. Liz
    NSW Australia
    Reply

    I knew someone taking lithium, and he seemed to have zero inhibitions.
    Just said inappropriate things. Embarrasing!

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