Lithium - Medication or Micro-Nutrient?

Lithium is an element that, at the present time, is considered non-essential to the human body. However, it is getting a lot of attention as a therapy, and there are interesting reports of beneficial actions of lithium. 

You might have seen our blog by Dr. James Greenblatt or one of the NY Times articles mentioning lithium. It is also coming up with frequency because of increasing awareness on mental health issues. There are lots of questions still to be answered, but we are excited about delving into them with you.

For this blog, I wanted to take a moment to introduce a new test for ZRT that ties in with our nutritional elements testing – lithium in dried urine.

Lithium Carbonate as a Medication

Most docs know of the prescription medication lithium carbonate, which has long been used for the treatment of manic-depression/bipolar disorder. It contains 18.8 mg of elemental lithium per 100 mg of lithium carbonate and was first used medically in 1871 to treat mania. Lithium carbonate treatment can be extremely successful, but does come with numerous adverse reactions depending on a person’s sensitivity to the medication as well as the dosage of lithium that they take.

Lithium carbonate commonly causes these side effects: changes to thirst and urination, vomiting, muscular weakness, changes to appetite, heart issues, skin and hair changes, fatigue, and thyroid disorders. In some cases, these adverse reactions are offset by the benefits that the patients might appreciate with the medication. So, it makes sense that there is a great deal of caution regarding other lithium salts.

Other Forms of Lithium

The most popular non-prescription form of lithium is lithium orotate, although many other salts of lithium have been researched and articles can be found on Pubmed by searching “microdose lithium” or “micro-dose lithium.”  Lithium orotate is the primary form available over the counter in America.

So why is it different from the medication? Well, honestly, it might not be, except in the dosage and better availability to brain tissue [1]. This idea that lower dosages may have benefits and fewer adverse reactions is not a new one. In fact, many elements or medications work this way with a low dose causing no problems, while toxicity is seen at higher dosages; or we might find benefits in naturally occurring elements that are not essential for life, such as gold. The use of low dose naltrexone vs. high dose naltrexone is another example. Lithium orotate contains 3.83 mg of lithium per 100 mg of the salt, significantly lower than in lithium carbonate. 

Lithium is a naturally occurring element. Many communities around the world have lithium in drinking water at significant levels and there are some positive associations with lithium intake. In the US, tap water levels seem to fluctuate from undetectable to 0.170 mg/liter. You can even buy lithium-containing water – Lithia spring water is available online containing 0.450 mg/liter and our “local town” of Ashland, Oregon itself has a Lithia water fountain right downtown, where from the early 1900s “drinking the waters” was thought to be good for you. 

In the early 1900s, it was also possible to purchase 7-UP with lithium – originally called “Bib-label Lithiated Lemon-Lime Soda” then “7-UP Lithiated Lemon Soda” joining other “good for you drinks.” It was known anecdotally, even then, that lithium was used to improve mood and was a constituent of many patent medicines of the day. In 1948 lithium was banned from soft drinks, likely due to the increasing use of the prescription lithium.

Current Research in Lithium Microdosing

There is new interest in low “microdosing” of lithium. Current research has been looking at Alzheimer’s disease and dementia, depression and suicidology, and mood stability.

Alzheimer’s & Dementia

Lithium intake at 10 µg per liter of water showed a 17% lower rate of dementia; however, lithium levels of 5-10 µg per liter were linked with a 22% increase in dementia, showing that the dosage is sensitive and that we have much to learn about this element [2]. However, there are some hints of neuroprotection and protective stress responses.

Depression & Suicidology

It is amazing to think that trace levels might actually influence behavior, but in fact lithium levels in community water does appears to be directly tied to levels of suicide, violence, and depression [3]. How does that work? Well, the idea that we are influenced by our environment is something that we commonly take for granted; for example, if we are exposed to carcinogens, we get increased cancer rates; lead dust in our houses or ground can decrease brain function; and trace perchlorate in our water increases hypothyroidism. 

Mood Stability

Mood stability is the most common usage for prescription lithium.  It often comes at a cost of managing adverse reactions by adjusting dosage. The breadth of mechanisms regarding lithium’s mode of action to create stability is largely unknown, although one specific target of lithium’s action involves glycogen synthase kinase-3 (GSK3) [4]. By inhibiting GSK3, lithium curbs brain inflammation, protects existing neurons and promotes the growth of new ones [5]. Additional ongoing research is suggestive of lithium’s role in regarding sodium transport and metabolism of catecholamine. There is also research indicating that phenylethylamine (PEA) stimulant activity is suppressed by lithium. Future studies can hopefully tell us how microdosing and prescription dosing work and when one form is warranted over the another.

Like Selenium, Lithium Could be Reclassified as Essential

In the 1930s, selenium was considered highly toxic to humans. It is still considered toxic at high doses, but an essential trace element for thyroid hormone synthesis and the catalytic metal of antioxidant enzymes at physiological doses. The Swiss alchemist Paracelsus is quoted as saying: “Poison is in everything, and no thing is without poison. The dosage makes it either a poison or a remedy.” The scientific literature is now pointing to the importance of low-dose lithium in maintaining health and preventing disease. It is not inconceivable that one day soon it will, like selenium, become an essential trace element.

Lithium Testing

ZRT’s urine lithium test is not a test geared for managing prescription lithium dosing.  This test is aimed at giving people a way to assess their intake through their drinking water or supplementation. This is a growing topic of research and it will be fascinating to see where the research takes us in the next 10 years or so. We will continue, as always, to bring you interesting articles and things to ponder as you are helping your patients.  

Many people have been getting some answers and help through ZRT's Heavy Metals & Nutritional Elements testing. We are excited that this test is already helping so many people and hope that the new lithium add-on assessment helps further.

Related Resources


[1] Kling MA, et al. Rat brain and serum lithium concentrations after acute injections of lithium carbonate and orotate. J Pharm Pharmacol. 1978;30(6):368-70.

[2] Kessing LV, et al. Association of Lithium in Drinking Water with the Incidence of Dementia. JAMA Psychiatry. 2017;74(10):1005-1010.

[3] Vita A, et al. Lithium in drinking water and suicide prevention: a review of the evidence. Int Clin Psychopharmacol. 2015;30(1):1-5.

[4] Luca A, et al. Gsk3 Signalling and Redox Status in Bipolar Disorder: Evidence from Lithium Efficacy. Oxid Med Cell Longev, 2016;2016:3030547.

[5] Chiu CT and Chuang DM. Neuroprotective action of lithium in disorders of the central nervous system. Zhong Nan Da Xue Xue Bao Yi Xue Ban, 2011;36(6):461-76.