Low-Dose Lithium: Very effective treatments for Mood Disorders

Pharmaceutical lithium carbonate is widely considered one
of the most effective medications in psychiatry for the treatment of bipolar depression.
However, due to the potentially toxic effects of lithium at high doses, many
doctors are reluctant to prescribe this drug. This reputation has unfortunately
pushed lithium of the limelight altogether like a viable choice for patients
struggling with depression or bpd.

There is an alternative way to effectively use lithium to deal with
depression and bpd, which would be to use the trace mineral at a lower dose
and bound to orotic acid.

Let me start by sharing 2 stories of patients:

Case Study 1

Jaia was 27 years old when she given to my
practice for consultation about her bipolar disorder type II. She experienced
severe depression and rage outbursts and had a history of being incarcerated for
vandalism of the parked car. Her mania was stabilized on the prescription paliperidone,
but her symptoms were nowhere near being controlled.

Hair mineral testing revealed low lithium status, therefore we started her on lithium orotate, 2 mg per day, which we slowly increased to 5 mg 3 times per day. Jaia quickly noticed her irritability lifting, and her anger outbursts disappeared.

Case Study 2

Twelve-year old Adam had been taken off 3 middle
schools by the time they called my office. He was very depressed and frequently
got into fights using the other students within the classroom. He was defiant together with his
teachers and had tantrums in your own home so severe that the police had been called
many times. In my office he glared at me, argued with his parents, and at
one point threatened to physically injure his mother if she kept talking. His
parents were reluctant to start him on any medications, but his symptoms were severe
plus they felt that they are out of options.

Hair mineral analysis showed a minimal lithium and
mercury. We examined his history for the supply of mercury exposure, and
learned that he had received silver amalgam fillings for 6 cavities when he was
a toddler. We know from the literature that mercury from silver dental fillings
could be a reason for depression, rage, and anxiety.1 I started Adam on lithium
orotate, 200 ug per day, and we
worked our in place to 2 mg/day. His parents also found a biological dentist, who
safely removed and replaced Adam's mercury fillings. Within 30 days his anger had
disappeared, and his behavior in class and also at home had improved. Testing was
repeated after A few months, which showed that his lithium levels had normalized
and the mercury levels were drastically reduced.

Lithium in Drinking Water & the Diet

Research has shown a powerful inverse relationship
between lithium consumption and also the incidence of violent crimes, arrests,
suicides, and drug dependency.2,3 These studies have also noted
statistically significant reductions in these behaviors in cities where
trace-element lithium orotate was added to water. Although optimal amounts
of lithium in drinking water haven't been established, lists of groundwater
lithium amounts
per state are readily available.4 Experts have suggested that,
with respect to the physical location, 1 mg lithium per liter of tap water
corresponds to approximately 6.9 mg lithium carbonate.5 Assuming
ingestion of <2 liters or water per day, this would translate to
roughly 1% of a standard therapeutic dose of lithium carbonate.

Elemental lithium – which is found in a number of foods,
including grains, vegetables, kelp, dairy, meat, fish, pistachios, and mustard
– is active in the actions of several hormones, enzymes, and vitamins.
Lithium is recognized as an important nutrient; the RDA for lithium for any 70 kg
adult is 1000 ug/day.6
While we realize that lithium is necessary, it is important to understand the
distinction between lithium orotate and lithium carbonate.

Lithium Orotate vs Lithium Carbonate

Lithium orotate is really a stable form of elemental lithium
that is certain to orotic acid. Lithium carbonate is really a pharmaceutical form of
lithium that's prescribed in high doses for the management of bpd
to prevent mania; it's also utilized in certain neurodegenerative diseases, such
as Alzheimer's disease.7 Animal studies claim that lithium orotate
is more bioavailable than lithium carbonate.8

Below is a quick look at the mg differences between lithium
carbonate and lithium orotate, as well as the average daily intake from dietary
sources and water in cities where lithium is present within the water supply9:

  • Lithium carbonate: 300 mg
  • Lithium carbonate: 150 mg
  • Lithium carbonate: 25 mg
  • Lithium orotate: 120 mg
  • Average dietary intake of elemental lithium: 1
  • Average
    consumption of elemental lithium when added to ground water: 5 mg/day

Lithium's Effect on Health

Lithium's importance in human health begins as soon as
conception. For example, lithium is important in fetal development.6
Lithium also supports the immune system by enhancing the activity of monocytes and lymphocytes.

Lithium is neuroprotective,10
among the possible reason for its clinical effectiveness in bpd. Animal
studies claim that lithium's neuroprotection happens in several ways. For
example, lithium stimulates stem cells within the brain by improving the release of brain-derived neurotrophic factor , which appears to be type in
neuronal longevity.11 Lithium also stimulates the discharge of
nerve-growth factor and changes genetic expression via epigenetics; NGF enables
the mind to carry on growing, healing, and developing.12 Increased
brain volume and cell density have been observed in bipolar patients taking
lithium carbonate.12

Lithium also enhances
the transport into cells of folate and cobalamin into cells,12 B vitamins that are utilized by every cell in your body
and which aid in all sorts of biochemical pathways, especially related to
neurotransmitter metabolism. This really is one among the mechanisms by which
lithium is mood-stabilizing, reducing mania and
aggression and lifting depression.12 In a tiny study of 24 former
drug-users, some of whom also were built with a history of violent behavior, 400 ug/d of oral lithium
significantly improved mood and stability compared with placebo.13

Low-dose lithium can augment the efficacy
of antidepressant medications.14 For all those
that are suffering from mood disorders, including treatment-resistant depression,
low-dose lithium supplementation may boost the drug's efficacy in addition to
prevent negative effects and drug toxicity related to high-dose
lithium treatment.

Lithium also exerts powerful antioxidant and anti-inflammatory
effects, thus helping to counter neurodegenerative diseases involving inflammation
and oxidative damage.12 The result is a wholesome brain and reduced
risk of neurodegeneration and mood instability. The study into Alzheimer's
is especially promising. In a mouse type of Alzheimer's disease, low-dose lithium
was proven to prevent beta-amyloid plaque accumulation and protect against
memory deficits.15 Lithium treatment continues to be associated with a lesser
incidence of dementia among aging adults.10

Dosing of Lithium

In the mid-1980s, the US Environmental Protection
Agency estimated that Americans' dietary consumption of lithium averaged between 0.6
and 3.1 mg/day.6 This is significantly less than those of individuals
residing in the Northern Argentinian Andes mountains, whose daily lithium
consumption is between 2 and 30 mg.16

Lithium intake requirements are influenced by a number of different
factors. For instance, since stress depletes lithium, those who endure
high physical stress may require higher levels of lithium.6 Those
exposed to heavy metal and rock toxicity could also require higher doses of lithium, as toxic
metals can deplete the mineral.17 Variations in individual lithium
metabolism, resulting from coadministration of medication that induce or inhibit
CYP450 pathways that clear lithium, would also impact dosage requirements.18

To determine optimal dosing for an individual considering
high-dose lithium, obtaining a lithium measurement is usually recommended.

A daily adult lithium consumption of 1 mg/day has been proposed.6
However, treatment dosages of lithium orotate vary from 200 ug to
25 mg. Within my own practice, I typically start my patients at 5 mg per
day, and then observe how they're feeling after 7 days. When they have the same or
better , I either keep them at that dose or increase it to five mg two times a day
. If any negative
reaction occurs, I reduce and sometimes discontinue their lithium supplementation.

It is my estimation that lithium
supplementation will have additional advantage
when coupled with high-dose omega-3 omega-3 fatty acids , as well as B-vitamin
complex, including folinic acid, methylcobalamin, and niacin. Supplementing a
complex of B vitamins offers greater value for brain function when compared with
supplementing single B vitamins.19 In patients with aggression and/or
past severe stress, the use of phosphatidyl serine,
L-theanine, taurine, glycine, and inositol might help optimize lithium's efficacy,
since all of these agents are GABAergic and neuroprotective20 and
together may be synergistic.

Lithium Toxicity

Lithium toxicity is much less likely to occur when dosed
as a trace mineral instead of as high-dose lithium carbonate. It is recommended
that any patient who has been in a current course of treatment with high-dose
lithium be looked into for a number of health metrics, the most crucial being tests for
thyroid16 and organs of detoxification, ie, kidney, and liver.21

Lithium overdose can be nephrotoxic and neurotoxic.22,23 Possible
the signs of lithium toxicity range from the following:

  • Agitation
  • Blood pressure abnormalities
  • Confusion
  • Diarrhea
  • Drowsiness
  • Fatigue
  • Muscle weakness
  • Palpitations
  • Seizures
  • Stomach pains
  • Tremors or uncontrollable movements
  • Urinary difficulties or pain
  • Vomiting

Lithium Testing

Testing lithium levels before and during high-dose
prescription lithium is important. Low-dose lithium is generally considered
quite safe. Lithium could be tested in the blood, urine, or hair. Typically,
blood tests for lithium are carried out to be able to figure out what dose of
lithium carbonate is most suitable for a patient. There's
a very narrow window of safety for lithium carbonate; serum levels range from 0.8
to 1.2 mmol/L, with 1.0 mmol/L considered optimal for a patient undergoing
treatment.24,25 Serum is useful for assessing current lithium levels;
however, I have found probably the most useful method to test average long-term lithium
levels is by hair analysis. Violent criminals have been discovered to possess really low
lithium concentrations in their hair samples,26 which reinforces the
hypothesis that low lithium may cause aggression and warrants supplementation
such individuals.


Pharmaceutical lithium carbonate is popular in the
management of bipolar disorder. However, our prime doses used pose a danger of
toxicity. Lithium orotate is a more bioavailable form of the mineral, and in
low doses is not only considered safe, but also efficacious within the management of
both mood and behavioral disorders. Lithium is also neuroprotective and
anti-inflammatory, thus offering promise in the area of dementia. Any patient
on or considering pharmaceutically dosed lithium carbonate ought to be tested and
closely monitored for nephro- and neurotoxicity.