Lithium in Nutritional Psychiatry

When I mention lithium, clients immediately picture mental asylums and frontal lobotomies. I think we can blame Hollywood for giving lithium such a bad name. The truth is that lithium is a natural salt. Drinking water is the most common source of  lithium although it also occurs naturally in some plant-derived foods (like thyme).

Historically, low levels of lithium in water supply corresponds with higher rates of suicide and depression.  Although a lithium deficiency syndrome has not been identified, people who are deficient in lithium intake can exhibit unstable moods,increased agitation, high levels of irritability and increased rates of suicide.

Over the years, lithium has been used for many different clinical applications. Lithium carbonate has generally been successfully used to treat patients with Bipolar Disorder, without psychiatrists really understanding how it works. However, the research now seems to be piling up on the beneficial effects of lithium. It is not unrealistic to assume that if lithium carbonate has a positive impact, lithium orotate, nutritional lithium (that typically found in drinking water), should too.

Why is lithium so amazing
  1. Brain-derived neurotrophic factor (BDNF) is well known for its involvement in neuronal maturation, differentiation and survival, synaptic plasticity, and long-term memory consolidation, and is highly expressed in the cerebral cortex and hippocampus. Numerous studies have reported decreased BDNF levels in patients with bipolar depression and mania, along with low levels of BDNF to be correlated with severity of depression and mania symptoms. BDNF gene polymorphisms have also been associated with the risk for Bipolar Disorder, early onset of the disease, suicidality, propensity toward rapid cycling, and treatment response. Lithium has been suggested to prevent cellular degeneration through BDNF upregulation, with chronic lithium treatment shown to increase BDNF.
  2. Lithium has been shown to modulate neurotransmitters including glutamate, dopamine, GABA, acetylcholine and glycine.
  3. Clinical use of lithium is associated with a lower incidence of dementia in old age. Moreover, excellent lithium responders have preserved cognition. Lithium-treated patients have better visual memory than non lithium patients.
  4. Lithium is associated with increases in hippocampal and cortical volume. Similarly, so does exercise.
  5. Lithium increases the length of telomeres whose preservation is necessary for maintaining both physical and psychiatric health. Lithium’s effects on telomeres occurs as a direct result of increasing the activity of the telomere elongation enzyme—telomerase. The longer one is on lithium, the more normal the telomere length becomes. Telomeres are shortened by childhood stressors, greater numbers of depressive episodes, and implacable anger, whereas they are lengthened by exercise, a good diet, mindfulness/meditation, and having positive and altruistic goals in life.
  6. Patients with Bipolar Disorder have reported lithium to decrease lipid peroxidation levels, and ameliorate mitochondrial dysfunction, which reverses the effects of oxidative stress.
  7. Lithium ions (at both high and low concentrations) have been shown to modify key cellular cascades that increase neuronal viability and resilience. Most prominently, lithium disrupts the key enzyme responsible for the development of the amyloid plaques and neurofibrillary tangles associated with Alzheimer’s disease. This enzyme is called Glycogen Synthase Kinase-3 (GSK-3)—a serine/threonine protein kinase that normally plays a major role in neural growth and development. In the healthy brain, GSK-3 is very important; it helps to carry out the synaptic remodeling that drives memory formation..

Whilst I’m not suggesting that everyone start taking lithium at high doses, I am suggesting that when started early, low-dose lithium may be the key intervention to prevent cognitive decline. But first, we must move past the stigma that surrounds it.

As psychiatrist Ana Fels wrote in her article for The New York Times, “[o]ne could make a case that lithium is the Cinderella of psychotropic medications, neglected and ill used.”  Lithium is the single most proven substance to keep neurons alive, and yet it continues to be viewed in the public mind as a dangerous and scary drug. Lithium is found readily in our environment, food, water and each and every cell in the human body. It is time we change the conversation around one of nature’s most effective and powerful neuroprotective remedies.