Redefining Lithium with Low Dosing

Karen tackles a listener question about low-dose lithium. She reviews micro- vs. low-dose ranges, discusses forms like lithium orotate/aspartate and third-party-tested supplement options, and flags safety essentials such as toxicity symptoms, thyroid/kidney considerations, and when to loop in your clinician.

Visit our website itchyandbitchy.com to read blog posts on the many topics we have covered on the show.

Episode Transcript

Speaker 1 (00:00):
The content of this podcast is provided for general informational
purposes only and is not intended as nor should it
be considered a substitute for professional medical advice. Hello, this

(00:22):
is Karen Nicol, family nurse practitioner, and you are listening
to Itchy and Bitchy, a podcast improvises answers to your
many unanswered health questions. I have so much fun getting
to know the people who have enrolled in my course,
The Perimenopause Answer, and they have so many good questions
for me. This week, one of the women in the

(00:43):
courus asked me about using low dose lithium to help
with mood. Again, I figured that if she had this question,
many of you out there may also have this question.
So guess what we're talking about lithium today. There has
been a stigma that hangs over the medication lithium. This

(01:04):
happened for a variety of reasons. It is a medication
that many people believe is only for severely ill patients,
and also the high doses used to treat patients from
the nineteen sixties to the nineteen eighties led to severe
side effects and the mistaken belief that it causes kidney damage.

(01:25):
Lithium is used as needed to treat mania that is
part of bipolar disorder. Mania is a condition in which
someone with bipolar disorder displays an over the top level
of activity or energy, or mood or behavior. Dosing of
oral lithium that is used for episodic mania is up

(01:46):
to fifteen hundred milligrams a day. This medication can also
be used on a daily basis versus as needed to
reduce the frequency and severity of manic episodes. The dosing
of the med taken orally for this use is up
to twelve hundred milligrams a day. I want you to
remember those numbers. Twelve hundred milligrams and fifteen hundred milligrams

(02:11):
per day of oral lithium. You may be asking at
this point, Karen, why are you talking to us about lithium.
I don't have bipolar disorder. Well. For the last few decades,
there have been studies to support the use of very
low doses of lithium for improved mood and cognitive function.

(02:33):
We also have studies on the benefits of using low
doses of the med for substance use disorder. A leading
functional psychiatrist, doctor James Greenblatt states in a Psychiatry Today
article that using low and microdose lithium for his patients
has been invaluable for helping with irritability, anger, and addiction.

(02:56):
In the world of medicine, lithium is not exc accepted
as a nutrient, but based on studies, lithium may be
considered a mineral a type of mineral. If it does
have qualities of a mineral. It could explain why microdoses
of the medication help people because they may actually be
dealing with a lithium deficiency. There are foods that are

(03:20):
lithium rich, like nuts, seeds, and legumes. Lithium is also
found wait for it, in drinking water. The amounts ferry
across the world, and in some regions like North Chile
and Argentina, there are very high concentrations of lithium in
their ground water and drinking water. Where your drinking water

(03:43):
is coming from also determines the lithium levels. Seawater has
twenty to one hundred times the content that fresh water has.
We actually have a study showing the benefits of lithium
just found in drinking water, and I will talk about
that after this quick break. Welcome back, What are the

(04:23):
benefits we can get from low doses or microdoses of lithium.
Based on the review of fourteen positive studies evaluating cognition, depression, suicide,
and substance use disorder, the strongest evidence for its use
is for the prevention of dementia and suicide. Some studies

(04:44):
show positive outcomes when using it for depression, substance disorder,
and irritability. I have talked about off label usage of
medications and previous episodes. For instance, it was noted that
when Paiians who had a history of migraines started taking
beta blockers to treat their high blood pressure, they had

(05:07):
fewer migraines. When this benefit was noted, it became common
practice to prescribe beta blockers off label, meaning not its
original intended use for migraines. Lithium has a similar history.
The cognitive benefits were first noted in those who were
taking lithium for bipolar disorder. Studies to examine the use

(05:32):
of lithium to treat Alzheimer's began when studies of those
treated with lithium for bipolar disorder experienced a significant reduction
in risk for dementia. Some of these clinical trials have
found benefits for slowing or halting the progression of cognitive
decline with lithium treatment. One double blind, placebo controlled clinical

(05:56):
trial that included one hundred and thirteen people with a
diagnosis of Alzheimer's disease were given three hundred micrograms micrograms
of lithium daily. I asked you to remember that we
used twelve hundred to fifteen hundred milligrams of lithium for

(06:17):
bipolar disorder. In this trial, they used three hundred micrograms,
which is the same as zero point three milligrams under
one milligram, which is a microdose of the medication. The
trial lasted fifteen months and the participants had an average

(06:38):
mini Mental Status Exam score of twenty out of thirty
points when the study ended. Those who were taking lithium
had many mental status Exam scores that remained the same
at the end of the trial, the same as the
beginning numbers, in other words, no decline, while those who

(06:59):
were taking the plus cibo continued to decline and had
an average MMS score of fourteen out of thirty at
the end of the study. A twenty twenty review of
multiple studies looked at almost sixty five hundred people with
bipolar disorder who were treated with prescription lithium at prescription

(07:20):
lithium doses of twelve hundred fifteen hundred milligrams a day.
They compared those treated with lithium to forty three thousand
people who were not on lithium treatment, and they found
that lithium treatment reduced dementia risk in the bipolar patients
by forty nine percent. A twenty eleven trial for low

(07:40):
DOS lithium for cognitive decline also found that the patients
on placebo worsened, whereas the patients on low DOS lithium
remained mostly stable. They did a final analysis of the
patients in this study in twenty twenty four. Of course,
many of those in the study had passed away between

(08:02):
twenty eleven and twenty twenty four, but the surviving study
participants who received lithium had higher memory scores than those
who were given a placebo, and the difference was significant.
Those on lithium had an average score of twenty five
point five out of thirty versus eighteen point three out

(08:25):
of thirty for the placebo group. Those on lithium also
had a much higher verbal fluency score compared to the
placebo group. We are seeing a rise in Alzheimer's disease
in dementia, and it is projected that those numbers will
continue to increase. Lithium treatment could be something to consider

(08:45):
using in addition to our current available treatments for Alzheimer's
and dementia. Earlier, I mentioned that lithium is in our
drinking water in varying concentrations depending on where we live.
Well In nineteen seventy it was noted that in one
area of the country, where the lithium levels increased in

(09:05):
the ground water, the levels in the tap water increased.
As the lithium levels increased in the drinking water, the
number of admissions to a state mental hospital in that
area decreased. Since that discovery, researchers have been studying the
relationship between lithium levels in drinking water and mental health outcomes,

(09:29):
especially the suicide rates. In twenty twenty one, a meta
analysis of the data gathered over these decades was completed.
The review included one hundred and thirteen million people in
almost twenty seven hundred regions across the globe. The study

(09:49):
found that the areas that have higher levels of lithium
in the groundwater, have fewer suicides and fewer admissions to
mental health facilities. The number of suicides in this country
continue to rise. Low dose lithium could be considered as
a safe addition to our current approaches for suicide prevention.

(10:13):
I want to take a moment here and remind everyone
that if you or someone you know is having thoughts
of suicide, or are going through a mental health or
substance use crisis or under emotional distress, please call or
text nine eight eight or chat online at nine eight

(10:35):
eight lifeline dot Org nine eight eight. We also have
studies showing the benefit of using low dose lithium for
those with major depressive disorder who have not responded to
treatment with SSRIs like Zoloft and s NRIs like effexor.
Significant benefits in reduction of depression symptoms were seen using

(11:00):
three hundred to four hundred milligram daily doses. Now, this
dose is low compared to the doses of up to
twelve hundred milligrams daily that I mentioned earlier that we
use for bipolar disorder, but these lower doses are way
higher than the microdoses of five milligrams and less that
were used in other studies. Substance use disorder is often

(11:25):
very difficult to treat, and clinical trials for meds to
treat the condition are difficult to complete due to the
high number of people in the study who drop out.
As a result, it is hard to collect and interpret
data for those with this condition. That being said, the
participants in studies using one hundred and fifty milligrams of

(11:48):
lithium avoided hospitalizations for alcohol use and showed resolution of
manic symptoms. Participants on one hundred and fifty milligrams of
lithium in one study had a fifty percent decrease in
opiate use, a ninety nine percent decrease in benzodiazepine use,

(12:08):
a seventy percent decrease in need for atypical antipsychotic meds,
and use of multiple illicit drugs decrease by seventy nine percent.
On top of that, the rates of program completion increased
by almost one hundred percent. Microdosing of a form called

(12:30):
lithium rotate can provide benefit for irritability. In doctor Greenblatt's
clinical experience, he states that for his patients quote struggling
with irritability, especially when there's a family history of addiction,
bipolar disorder, or depression. Elemental lithium between two and ten milligrams,

(12:52):
typically as lithium orotate, has provided significant relief in quote.
Microdoses of litium are available over the counter. These products
are not regulated by the FDA, so if you take
an over the counter lithium supplement, it is important to
choose a product that has been third party tested to

(13:15):
ensure that it has the strength listed on the label,
that it is free of specific contaminants, and that the
product breaks down well so your body can use it.
There are three lithium supplements that are approved and are
top picks by Consumer Labs, a third party testing company.

(13:38):
Two of them are five milligram capsules, Swanson's Lithium rotate
five milligram capsule, and Solarrays Lithium aspartate five milligram capsule.
A lower dose option that contains one thousand micrograms, which
is one milligram of lithium rotate, is Life Extensions Memory

(13:58):
Protect capsule. It is believed that the form of lithium oritate,
which is contained in the Swansen and Life Extension products,
has better absorption with fewer potential side effects compared to
the form of lithium aspartate that is in the solarray product. However,
both are effective to help with mood and cognitive function.

(14:20):
Even with these very low doses of lithium, there can
be some risks involved in taking it. Be aware that
taking too much of any form of lithium can cause toxicity,
so more is it necessarily better. Symptoms of toxicity include lethargy, vomiting,
difficulty with balance, and muscle trimmers. Long term use of

(14:43):
a moderate dose moderate dose of lithium can affect your
thyroid function, and high doses like we use in bipolar disorder,
have been linked to kidney problems. Although lithium is not
officially considered a micronutrient, some experts argue that lithium should

(15:03):
be recognized as a trace element given the evidence of
anti suicidal and neural protective effects even when using microdoses.
Using an integrated medicine approach, microdoses of lithium may act
like a nutrient supplement that can improve mood, reduce irritability,

(15:24):
and support cognitive function. Thank you so much for listening.
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(15:48):
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As always, thanks to Forrest winzel my Son, our producer
and composer of our theme music and the person who

(16:10):
does all the behind the scenes work to make this
podcast possible. Thank you Forrest. Forrest is deep into his
first semester of his second year of his master's degree
in music composition at Peabody Music Conservatory and is really
loving it. So so proud of him. Remember that your
health is a