Lithium orotate is a mineral supplement combining lithium with orotic acid. It has garnered attention as a non-prescription alternative to lithium carbonate, a medication used in treating bipolar disorder, depression, and self-harming behavior. While lithium orotate is often marketed as a gentle, low-dose form of lithium that may support mood balance, brain health, and stress resilience, it's important to approach it with caution and consider both its potential benefits and possible side effects.
Understanding Lithium Orotate
Lithium orotate is available in smaller, non-prescription doses, unlike prescription lithium carbonate. It is often chosen for its perceived benefits, including support for cognitive health, mood balance, or general wellness.
Forms of Lithium Supplements
- Lithium orotate: A salt with orotate, a naturally occurring substance in the body. Patients taking lithium orotate may experience fewer side effects compared to lithium medication, possibly because it is prescribed at much lower doses. It usually comes in 5mg capsules.
- Ionic lithium: A liquid form containing lithium chloride, which can be helpful for children or patients sensitive to treatment, as it is easy to start at a low dose and build up to a therapeutic dose.
- Plant-based lithium: A unique form of lithium made from vegetables grown in high-dose lithium soil. It may be better absorbed and utilized, as our bodies are used to digesting lithium in plants.
Potential Benefits of Lithium Orotate
Some emerging research suggests that lithium orotate may play a role in supporting cognitive health and potentially help reduce the risk of age-related decline, including the progression of Alzheimer's disease. There are also anecdotal reports and early findings indicating that it may support mood, ease stress, and promote mental clarity.
- Cognitive Health: Emerging research suggests lithium orotate may support cognitive health and reduce the risk of age-related cognitive decline, including Alzheimer's disease.
- Mood Balance: Anecdotal reports and early findings suggest it may support mood, ease stress, and promote mental clarity.
Lithium's Role in Mental Health
Lithium is a mineral with unique properties in terms of its effects on the brain and mood. While most prescription psychiatric drugs work on neurotransmitters by interacting with receptors on the outside of the cell membrane or by increasing the amount of certain brain chemicals like serotonin or dopamine, lithium can get inside the brain cells (the neurons), affecting the inner workings of the cell itself in ways that can greatly benefit mood.
Potential Applications of Low-Dose Lithium
- Dementia Prevention: Studies on patients with bipolar disorder who were on lithium as a mood stabilizer found that lithium treatment significantly reduced the risk of dementia. A trial found potential benefits with 300 µg of lithium per day, where patients with Alzheimer's disease remained stable over 15 months. Another trial of low-dose lithium for cognitive decline found that lithium-treated subjects had a decrease in phosphorylated tau in cerebrospinal fluid (CSF) and better cognitive function.
- Suicide Prevention: Evidence for microdoses reducing suicide risks comes from ecological studies exploring suicide rates and lithium levels in tap water. Higher groundwater lithium was correlated with reduced suicide and mental hospital admissions. Standard pharmaceutical doses of lithium have also shown consistent effects for lowering suicide risk in patients with bipolar disorder.
- Resistant Depression: Low-dose lithium augmentation has shown significant benefits in severely depressed patients unresponsive to an initial trial of venlafaxine.
- Addiction Recovery: Low-dose lithium may have a role in helping to treat addiction. An early study using an integrative medicine approach for treatment using 6 mg of lithium (as 150 mg of lithium orotate), combined with other supplements and dietary recommendations, found benefits for patients with alcohol use disorder.
- Anger and Irritability: Elemental lithium between 2 and 10 mg, typically as lithium orotate, has often provided significant relief for patients struggling with irritability, especially when there is a family history of addiction, bipolar disorder, or depression.
Potential Side Effects and Risks
Even though lithium is available as a supplement, it is not free from risks. People who experience persisting side effects should talk to a medical professional. Additionally, individuals with kidney conditions, pregnant women, and children should not take lithium orotate without medical advice. Combining lithium orotate with other supplements or prescription lithium can increase risks.
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- General Side Effects: Lithium prescription drugs can cause muscle weakness, fatigue, weight gain, and other side effects.
- Precautions: Individuals with kidney conditions, pregnant women, and children should not take lithium orotate without medical advice.
- Interactions: Combining lithium orotate with other supplements or prescription lithium can increase risks.
Populations Sensitive to Lithium
Certain populations, such as the elderly and pregnant women, may be sensitive to long-term exposure to small amounts of lithium. Lithium orotate contains a higher dose of lithium than other supplements, so there is some potential for side effects and toxicity. However, this typically occurs only when multiple capsules at higher doses are taken.
Potential Interactions with Medications
- Antidepressant Drugs: Lithium increases a brain chemical called serotonin. Taking lithium along with medications for depression might increase serotonin too much and cause serious side effects including heart problems, shivering, and anxiety.
- MAOIs: Taking lithium with MAOIs might cause there to be too much serotonin.
- Dextromethorphan: Taking lithium along with dextromethorphan might cause too much serotonin in the brain and serious side effects including heart problems, shivering, and anxiety could result.
- High Blood Pressure Medications: Some medications for high blood pressure can increase lithium levels in the body.
- Seizure Medications: Taking lithium along with some medications used for seizures might increase the side effects of lithium.
- Methyldopa: Taking methyldopa might increase the effects and side effects of lithium.
- Methylxanthines: Taking methylxanthines can increase how quickly the body gets rid of lithium.
- Muscle Relaxants: Lithium might increase how long muscle relaxants work.
- NSAIDs: NSAIDs might increase lithium levels in the body. Taking lithium along with NSAIDs might increase the risk of lithium side effects.
- Phenothiazines: Taking phenothiazines along with lithium might decrease the effectiveness of lithium.
- Tramadol: Tramadol can affect a chemical in the brain called serotonin. Lithium can also affect serotonin.
- Loop Diuretics: Some "water pills" can increase how much sodium the body gets rid of in the urine.
- Thiazide Diuretics: Taking lithium with some "water pills" can increase the amount of lithium in the body.
- Pentazocine: Taking lithium along with pentazocine might cause too much serotonin in the body.
Important Warnings
- Using lithium during pregnancy can harm the unborn baby.
- Call your doctor right away if you have diarrhea, vomiting, drowsiness, muscle weakness, tremors, unsteadiness, or other problems with muscle control or coordination, as these may be symptoms of lithium toxicity.
- Make sure your doctor knows if you have a heart disorder called Brugada syndrome.
- Call your doctor or the emergency department right away if you have a fast, pounding, or uneven heartbeat, unexplained fainting, lightheadedness, or troubled breathing after using this medicine.
- This medicine may cause pseudotumor cerebri (increased pressure in the brain).
- Encephalopathic syndrome (brain problem) may occur in patients using this medicine together with a medicine to treat mental illness.
- Check with your doctor right away if you have anxiety, restlessness, a fast heartbeat, fever, sweating, muscle spasms, twitching, nausea, vomiting, diarrhea, or see or hear things that are not there, as these may be symptoms of a serious condition called serotonin syndrome.
- Use extra care in hot weather and during activities that cause you to sweat heavily.
- If you have an infection or illness that causes heavy sweating, vomiting, diarrhea, shakiness, or muscle weakness, check with your doctor right away.
- Do not go on a diet to lose weight and do not make a major change in your diet without first checking with your doctor.
Dosage and Administration
Lithium orotate is usually taken in low doses, most often providing around 5 mg of elemental lithium per day. However, more is not always better. Even at low levels, lithium can influence cognitive function and bodily processes, meaning lithium orotate may still cause noticeable effects. Some people use it occasionally for short periods, while others take it more regularly.
- To experience potential benefits, it may be best to use it consistently for around six weeks before reviewing whether it’s right for you.
- Because individual sensitivity varies, even low-dose supplements may not be suitable for everyone.
- Exceeding the recommended amount can increase the risk of side effects.
- The NHS generally recommends taking forms of lithium in the evening.
Spectrum of Lithium Intake in Humans
At this time, there isn’t enough research to determine what the required daily intake of lithium should be. Dr. Schrauzer, professor at U.C. San Diego and director of the Biological Trace Element Research Institute, has made a provisional recommendation that the daily requirement for lithium should be 1mg/day for an adult of average weight.
Dosing Considerations
- There isn't enough reliable information to know what an appropriate dose of lithium might be in supplements.
- Speak with a healthcare provider to find out what type of product and dose might be best for a specific condition.
- Adults often start with 5-10 mg daily for the first week or two, and then increase to 10-20 mg daily if needed and well-tolerated.
- Lithium orotate can also be utilized in children and teens with ADHD, Autism, DMDD, or depression who experience emotionally reactive, angry, and aggressive behaviors.
The Broader Context of Lithium in Medicine
Lithium salts have been used for more than half a century to address the psychiatric manifestations of BD, most notably the control of mania and the prevention of mood‐disturbance recurrences. Lithium is thought to contribute to the management of affective disorders through a variety of mechanisms, with the antagonism of GSK3β and IMPase standing as perhaps the most prominent one.
Historical Perspective
The use of lithium in psychiatry has roots in the mid‐1800s. In 1871, William Hammond became the first physician to prescribe lithium for mania, specifically lithium bromide. By the late 1890s, Li2CO3 had been used in the treatment of 35 patients with melancholic depression in Denmark. In 1949, John Cade hypothesized that excess uric acid was related to mania and began treatment on 10 manic patients with lithium citrate and Li2CO3.
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Lithium Carbonate vs. Lithium Orotate
Lithium carbonate (Li2CO3) is an efficacious therapeutic option in BD, but a troublesome side effect profile limits patient compliance. LiOr is proposed to cross the blood-brain barrier and enter cells more readily than Li2CO3, which will theoretically allow for reduced dosage requirements and ameliorated toxicity concerns.
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