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Rediscovering Lithium for Mood Disorders

Lithium is a mainstay for treating bipolar disorder. Side effects are scary, but could low-dose supplements be safer and more effective for mood disorders?
Rediscovering Lithium for Mood Disorders
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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, 1951).

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 Medications:

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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About the Author
Joe Graedon is a pharmacologist who has dedicated his career to making drug information understandable to consumers. His best-selling book, The People’s Pharmacy, was published in 1976 and led to a syndicated newspaper column, syndicated public radio show and web site. In 2006, Long Island University awarded him an honorary doctorate as “one of the country's leading drug experts for the consumer.” .
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