Low Dose Lithium


 

We are in a mental health crisis of epidemic proportions.  Rates of addiction, mass violence and suicide have been and are still rising.  This data is evidence of the failures of both society and mental health treatment.  As a psychiatrist, I’m disappointed on how short we’re falling in addressing this crisis but there are ways forward.  Apart from macro-changes, there is a solution that is natural, staggeringly effective and even available over the counter.  After all, if you were descending into darkness or saw your child doing so, wouldn’t you want this information? I certainly would but even in my extensive training, I was never enlightened about the true power of Lithium.  

My journey of discovery was born from the frustration of using underwhelmingly effective medications with overwhelming side effects.  I asked myself, can’t we do better than this? If lithium is so effective against the deep despair of Bipolar, maybe it could be useful at lower doses for other conditions.  To soothe self-destructiveness in people with a history of trauma or to extinguish suicidal impulses. Turns out it can and there is a world of data and stories to prove it. And yet, it remains at the bottom of the top 25 most prescribed psychiatric medications.  This is like putting your best hitter last.

So, let me tell you about this salt of the Earth, this dust from the stars, this hand of God.

Starting from the beginning, the real beginning; at the Big Bang 13.7 Billion years ago when the top three elements were H, He and Li.  That third element being the only solid in its natural state. You could say it’s the dynamite that ignited the whole thing. It’s electric! A metal, a salt that conducts and stores energy in batteries and potentiates it in the brain.  The best explanation that psychiatry has for how it works is that it improves second messenger pathways. Like adding a few lanes to a traffic jam. Hence sprinkling a bit of this salt into the marinade of the brain spreads neuronal activity from regions that are too “hot” to regions that are underactive.  

Like any element, the amount is key.  For example, a potassium drip can save your life if you’re deficient from a GI illness but the injection of a larger amount will end it.  There are also known deficiencies of other metals like iron or copper. Hyponatremia or low sodium can lead to seizures and death. Lithium being both metal and salt, one can make a case that we are collectively suffering from a deficiency of it.  Fluoride is to dental health the way lithium is to mental health.

Most lithium prescriptions are to control Bipolar or Schizophrenia variations, ranging from 450-1200 mg per day and may be life-saving but also include side effects that need monitoring.  At doses of 1/10 that or even as low as 1mg , there is increasing evidence of benefit to people with nearly any psychiatric condition or even those without one. Examples include the improvement of anxiety, reduction of self-destructive behavior for people with a history of abuse, prevention and reduction of suicidal thinking and behavior, deepening of sleep and the reduced occurrence of Alzheimer’s disease.

A meta-analysis of peer reviewed studies since 1970 showed the clear anti-suicidal effects of Lithium.  And yet a resident psychiatrist recently told me she avoided using it because she was concerned about the potential of overdose.  Tylenol can be fatal in overdose but we’re not taking that off the shelves anytime soon. Our fear of the effects of high doses is preventing us from seeing the hope provided by low doses.

Studies on the boosting of antidepressants with low dose Lithium led to improvements without the side effects found above 450mg.  The LITMUS study in Texas found the same for Bipolar patients who were traditionally thought to require a minimum lithium level of 0.4mg/dl.  Apparently an even lower amount was effective and sparing of the usual side effects. We could go through more of the half a million related publications on Google Scholar or PubMed but only recently are we beginning to explore the potential of using lower than normal dosing.  

The question then is how low?  Some studies show a reduction in Alzheimer’s occurrence with the use of only 1mg per day.  Or how about the epidemiologic data on natural lithium in ground water? How the population in those areas have lower rates of suicide and homicide.  Association is not causation but nor can it be ignored. After all, the founder of modern medicine Galen was known for recommending a local lithiated spring to all of his patients.  Even as recently as 100 years ago, visiting such springs in the US was common. So much that the first bottled waters were sold as Lithiated water.

I can also tell you about the 201 patients in my practice who have benefitted uniquely from 150mg or less.  Who have used it to see both blame and forgiveness for their pain, to use as an emotional brace in order to begin necessary therapy, to help avoid the dark logic of fear and violence,  to assist in kicking addiction, and to not only literally dream again but awaken with the audacity to pursue them.

Hence there is significant medical, associative and anecdotal data.  Also, the Amazon reviews of Lithium supplements are astounding. But there are no commercials advertising this, no kickbacks to doctors for prescribing it and no promises to fund congressional campaigns.  So the information that can help take us towards the light, stays in the dark.

We can do so much better as mental healthcare providers, as a country.  Like care more holistically or how about provide any care each other so that 50% of counties don’t lack a single psychiatrist.  Let’s see the value of brain health as we do the body so that stigma ends. Let’s tax and regulate intoxicants appropriately including guns because the majority of related deaths are suicides.  Show how greed and inequality is tearing the fabric of society. Preach the strength of diversity to soothe the phobia of the other. And start bridging the sacred and secular rather than scoffing at each.  

They’re all fails but our top one is not using or sufficiently studying the most effective and natural anti-suicidal and anti-violent mineral in the universe: Lithium.  Because when the Sun expands, it would be nice to be long gone from our home. To achieve that level of progress will require a more symbiotic relationship with each other and this planet.

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Sudhir Gadh, MD
41 East 11th Street, 4th Floor (btw University & Broadway)
New York, NY 10003
Phone: 917-502-4529
Fax: 917-591-5282
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