Reasons not to believe in lithium

‘I don’t believe in God, but I believe in lithium’ is the title of Jamie Lowe’s moving account of her manic depression (now usually referred to as bipolar disorder) in the New York Times ( The piece reminds us how devastating and frightening this condition can be, so it is understandable that the author put her faith in the miracle cure psychiatrists have been recommending since the 1950s: lithium.

Lowe took lithium from the age of 17 for 20 years, until at the age of 37 or thereabouts she was diagnosed with kidney failure, a direct result of this treatment. She will need dialysis, and a kidney transplant – a high price to pay for a really effective treatment. The sad thing is, we have little evidence that lithium is a really effective treatment, or even that it is effective at all. However, as I explain below, once someone starts on lihium, there is evidence that there is a high risk of having a relapse if they stop it. This is not the same as showing that lithium is a good thing in the first place, but it does mean that people who are already taking lithium have to be very careful if they decide they want to come off.

Lithium is a neurotoxin. It inhibits the functioning of the nervous system so that people typically feel drowsy, lethargic and slowed up. These effects were observed in guinea pigs initially, and then in people with mania by the Australian doctor, John Cade, who first proposed that lithium might be a useful treatment for manic depression (1). In the 19th century lithium had been used for the treatment of gout, and became a popular ingredient of tonics and even beer, until it was shown that it did not dissolve the uric acid crystals that cause gout as had been claimed (2).


The sedative and slowing effects of lithium, although usually described as side effects, account for why lithium can help reduce arousal and activity levels in people with acute manic symptoms. So there is nothing magic or specific about lithium’s action in manic depression. Lithium will exert its characteristic effects in anyone, whether or not they have mania or manic depression.  In theory, these effects might suppress the emergence of a manic episode, as well as reduce the severity of symptoms once an episode has started. The evidence that long-term lithium treatment reduces the occurrence of manic or depressive episodes is actually very weak, however.

The main problem with the evidence is that there is no study in which people who have been started on lithium have been compared with people who haven’t. Every randomised trial of lithium versus placebo starts with people who are already on drug treatment of one sort or another, often lithium itself. Now there is good evidence, accepted by leading proponents of lithium (3;4), that withdrawing from lithium can precipitate a relapse of manic depression, especially a manic episode. Three studies have shown, for example, that people are more likely to have a relapse after stopping lithium than they were before they started it (5-7). No one knows the mechanism for this, but it is as if removing the neurological suppression produced by lithium causes the nervous system of a susceptible person to go into over-drive, precipitating a manic relapse.

So demonstrating that people who stop lithium and start a placebo have higher rates of relapse than people who continue on lithium does not demonstrate that going onto lithium in the first place prevents episodes.  But all the placebo-controlled trials of lithium are like this to at least some degree. The trial that established the idea of long-term lithium treatment, for example,  started with people who had already been on lithium for many years (8). In more recent studies, not all participants have been on lithium prior to enrolment, but those not taking lithium were likely to be taking other sorts of sedative medication. The first of these recent studies, the largest study up until that point involving 372 participants, found no difference between lithium, sodium valproate and placebo in terms of the rate of recurrence of any type of mood episode (9). The second found a higher rate of manic relapse in placebo-treated patients compared with those on lithium, but the pattern with which relapses occurred was strongly suggestive of a discontinuation effect. A large majority of relapses occurred in the first few weeks after allocation to placebo, and none occurred in the last few months of the study, suggesting that the point of discontinuation of previous medication was associated with subsequent relapses (10). In the final trial, rates of mania were higher in people on placebo by about 14% (14% vs 28%), but 20% of participants were taking lithium before randomisation, and still others were taking Depakote or antipsychotics, all of which were stopped relatively abruptly prior to the trial (11).

The possibility that relapses in the placebo groups in these trials are induced by withdrawal of previous medication would make sense of the fact that it has proved impossible to demonstrate that people receiving modern drug treatment for manic depression do any better than those who don’t, or didn’t. In fact, overall, they seem to do slightly worse.

Two important studies have examined rates of relapse in people with classical manic depressive symptoms prior to the 1950s. American psychiatrist George Winokur found the records of 100 patients admitted to a psychiatric hospital between 1934 and 1944 with an episode of mania and then followed them up through their hospital records. He found that 48% had a relapse requiring hospitalisation over an average follow-up duration of 3.2 years. For comparison purposes this equates to a relapse rate of 15% per year (12). Margaret Harris, David Healy and colleagues did the same for patients admitted to the North Wales asylum in the 1890s. They found that, on average, patients had 4 relapses over the subsequent 10 years, equating to a relapse rate of 20% a year.  In comparison, during the 1990s, people with manic depression (most of whom we can assume were on drug treatment) were having an average of 6.3 admissions in 10 years, or 31% per year, for example (13). That’s over 10% higher than the rate of admission for people in the 1890s!

Relapse rates among patients taking lithium in randomised trials that have started with patients experiencing a manic episode (as the historical studies did) are uniformly higher too. In the comparison between lithium, Divalproex (Depakote) and placebo, for example, the lithium group relapsed at a rate of 31% a year (9). In the comparison between lithium, lamotrigine and placebo in people with mania it was 26% a year (10). Admittedly these figures include all relapses, and not just those severe enough to require hospitalisation. A large study conducted in the 1970s, however, found that rates of hospital admission for relapse were 21.5% per year in the lithium group (14).

Several ‘naturalistic’ studies have tracked the progress of people taking lithium and other treatments. The vast majority of these studies also show high relapse rates among those on lithium, even though most studies highly compliant populations and we know that people who are compliant with any treatment (including placebo) have better outcomes than those who are not. One study of patients who were known to be compliant with their lithium treatment for at least a year, for example, found a rate of relapse of 40% a year over a 6 year follow-up (15).

In my view the evidence that lithium helps prevent episodes of manic depression is far too weak to outweigh the harms it can cause (which commonly include thyroid damage, kidney damage, and acute neurological toxicity at doses very close to those used in practice, hence the need for blood monitoring). Manic depression is a highly variable condition. Some people have many episodes, some people few, and the pattern of episodes varies throughout life as well. Long periods of remaining well are not necessarily evidence of a treatment’s effectiveness.  What we would need to demonstrate the efficacy and value of lithium is a prospective randomised trial in which people who had not previously been on long-term drug treatment were randomly allocated to start lithium or placebo. At present, my view is that the evidence that lithium might be effective is not strong enough to justify such a trial, given the health risks associated with it.

As Jamie Lowe eloquently expresses, manic depression can be a terrifying condition, and I know that people will say therefore ‘if not lithium, then what?’.  But the evidence that any long-term drug treatment is better than nothing is not strong (1). Many doctors and patients are very uncomfortable with that conclusion, and feel there just has to be something. And if people want to try some sort of drug treatment, like antipsychotics or anticonvulsants, then I feel that doctors should help them take it as safely as possible, at as low a dose as possible. But doctors should be honest about the state of the evidence and for lithium, I am not convinced there are any circumstances that justify the risks it entails.

In 1957 a pharmacologist bemoaned the fashion for treatment ‘by lithium poisoning’ (16). One day, I believe, we will wake up and realise his concern was spot on!

Reference List

(1)    Moncrieff J. The Myth of the Chemical Cure: a critique of psychiatric drug treatment. Basingstoke, Hampshire, UK: Palgrave Macmillan; 2008.

(2)    Johnson FN. The History of Lithium Therapy. London: Macmillan; 1984.

(3)    Franks MA, Macritchie KAN, Young AH. The consequences of suddenly stopping psychotropic medication in bipolar disorder. Bipolar Disorders 2005;4(1):11-7.

(4)    Goodwin GM. Recurrence of mania after lithium withdrawal. Implications for the use of lithium in the treatment of bipolar affective disorder. Br J Psychiatry 1994 Feb;164(2):149-52.

(5)    Baldessarini RJ, Tondo L, Viguera AC. Discontinuing lithium maintenance treatment in bipolar disorders: risks and implications. Bipolar Disord 1999 Sep;1(1):17-24.

(6)    Suppes T, Baldessarini RJ, Faedda GL, Tohen M. Risk of recurrence following discontinuation of lithium treatment in bipolar disorder. Arch Gen Psychiatry 1991 Dec;48(12):1082-8.

(7)    Cundall RL, Brooks PW, Murray LG. A controlled evaluation of lithium prophylaxis in affective disorders. Psychol Med 1972 Aug;2(3):308-11.

(8)    Baastrup PC, Poulsen JC, Schou M, Thomsen K, Amdisen A. Prophylactic lithium: double blind discontinuation in manic-depressive and recurrent-depressive disorders. Lancet 1970 Aug 15;2(7668):326-30.

(9)    Bowden CL, Calabrese JR, McElroy SL, Gyulai L, Wassef A, Petty F, et al. A randomized, placebo-controlled 12-month trial of divalproex and lithium in treatment of outpatients with bipolar I disorder. Divalproex Maintenance Study Group. Arch Gen Psychiatry 2000 May;57(5):481-9.

(10)    Bowden CL, Calabrese JR, Sachs G, Yatham LN, Asghar SA, Hompland M, et al. A placebo-controlled 18-month trial of lamotrigine and lithium maintenance treatment in recently manic or hypomanic patients with bipolar I disorder. Arch Gen Psychiatry 2003 Apr;60(4):392-400.

(11)    Calabrese JR, Bowden CL, Sachs G, Yatham LN, Behnke K, Mehtonen OP, et al. A placebo-controlled 18-month trial of lamotrigine and lithium maintenance treatment in recently depressed patients with bipolar I disorder. J Clin Psychiatry 2003 Sep;64(9):1013-24.

(12)    Winokur G. The Iowa 500: heterogeneity and course in manic-depressive illness (bipolar). Compr Psychiatry 1975 Mar;16(2):125-31.

(13)    Harris M, Chandran S, Chakraborty N, Healy D. The impact of mood stabilizers on bipolar disorder: the 1890s and 1990s compared. Hist Psychiatry 2005 Dec;16(pt 4 (no 64)):423-34.

(14)    Prien RF, Caffey EM, Jr., Klett CJ. Prophylactic efficacy of lithium carbonate in manic-depressive illness. Report of the Veterans Administration and National Institute of Mental Health collaborative study group. Arch Gen Psychiatry 1973 Mar;28(3):337-41.

(15)    Tondo L, Baldessarini RJ, Floris G. Long-term clinical effectiveness of lithium maintenance treatment in types I and II bipolar disorders. Br J Psychiatry Suppl 2001 Jun;41:s184-s190.

(16)    Wikler A. The Relation of Psychiatry to Pharmacology. Baltimore: Williams & Wilkins Co; 1957.

52 thoughts on “Reasons not to believe in lithium

  1. Thank you Joanna for posting this. My mom was on lithium for years and it only made her worse, plus added side effects. I convinced her to come off of it and she has done much better since. She said originally that she was afraid to come off of it because she was afraid that she would have a socially devastating social interaction… but the lithium was giving her psychosis, which isn’t a help with social interactions. – Yvonne


  2. Thank you for this excellent review Joanna. It’s opened my eyes and supports my practice of prescribing micro-doses of lithium, as the orotate, 5mg or 10mg daily, max. Moore as a nutritional supplement than a “treatment” for bipolar disorder.

    I very much appreciate all your research and considered writings, which truly are evidence based. Those of us who are integrative psychiatrists (about three, I think, in Australia) are greatly supported by your work.

    Chris Corcos, psychiatrist


    • Hi Chris

      I want to sway from carbonate to orotate. Neither my G.P. or Psychiatrist will assist understandably. I don’t know a reputable brand or what doseae i could try. The more I read the more confusin. Any advice would be appreciated

    • Chris, using a very low dose of lithium orotate may be enough to prevent or alleviate eventual dementia, but is possibly too low for short-term psychiatric benefit. I suggest the prescribable 150 mg “pediatric” capsule, which is what I take after 40 years on full-dose lithium weakened my kidneys. Long ago, Schou tested equivalent levels of lithium orotate and carbonate in rats, and found that the had equal access to the brain. But the orotate ion was somewhat harder on the kidneys than the carbonate ion. I’ve not yet found research showing superiority of lithium orotate.

  3. Pingback: Lithium and suicide: what does the evidence show? | Joanna Moncrieff

  4. Pingback: Lithium and Suicide: What Does the Evidence Show? - Mad In America

    • This is scary if the L O is the reason for this horrible feeling.
      I have only taken 4 times .
      Suggested from a friend to start.
      I also take 40mg Prozac.
      I was cautious about starting a new product.
      Nevertheless I bought and tried.
      I am wondering sudden errey feeling
      Sudden and more panic attacks.
      I have decided to not take anymore.
      Tell me your insight please.

  5. Thank you, this was an interesting article that I tend to agree with. The extensive list of sources that accompanies it was appreciated as well.

  6. I’ve read a couple different articles about Lithium, and the negative effects that go along with it. Unfortunately, after 15 years of trying many different medications for my bipolar, it seems to be the only thing that works for me. I started to improve within a week of starting it, and finally feel as close to “normal” as I can imagine after three years. I feel absolutely none of the side effects mentioned, and I have a lithium level blood test done every three months to make everything looks good with regards to liver and kidney function. While I understand the importance of bringing to light the dangers of all medications, I think its also dangerous to call a life saving medication “poison”, or to imply it is a placebo. Everyone has a different reaction to every drug.

    • Dear Shannon,
      thank you for your comment. I can understand your relief to be returning to normal life after years of bipolar episodes. However, I do think it is important to understand the limitations of our evidence for the benefits of lithium, especially in view of the serious complications that its use can lead to (although thankfully not in everyone – I am glad you are not experiencing any negative effects).
      The resaon that randomised controlled trials are performed is that we can never predict the natural history of mental disorders. People with bipolar disorder have very variable patterns of episodes throughout their lives. It is not the case that everyone with bipolar disorder has a predictable pattern of episodes occuring, for example, every one or two years. Some evidence suggests that episodes tend to cluster in some people – that is people have a few episodes in a few years, followed by a period of being well. Whatever the pattern of bipolar disorder, the point is we need randomised trials to work out whether a new treatment reduces the number of episodes that would occur naturally without treatment. I just don’t think we have good enough evidence to conclude that lithium does this.
      I can understand that someone who has gone through a lot of episodes will be desperate to find something that will stop them. In this situation, I can see that anything for which there is some evidence that it might be helpful might seem worth trying. I completely support your choice to do this. But I think it is important that everyone in your position has access to a view about the limitations of the evidence in order to make this decision.

    • If you’re scared of the Kidney exaggeration with Lithium, drink and lots of Boiled white radish to clear the kidneys. Unless the world becomes a perfect place with no bullying bosses, economic cast systems, abusive parents etc, their really isn’t any cure to bipolar. The triggers never change and neither could our brains to deal with them. The meds help.

  7. Like everybody else who talks crap on the internet, you do a great job of trying to scare people out of my medicine for bipolar and make a killing with your books and talks I bet. Could you please, if you truly believe in everything you preach, provide all of your books, lectures,..everything, in electronic format for FREE. Also, throw in your books in print and visits..All for FREE. And, tell the shit talking “yes” people on your comments boards who either have taken lithium or like always, “know somebody” who took it, that they should get out of the house and do something instead of troll the internet for cyber attention. Lithium works, period. Your article is shit disturbing. Please, be bipolar with me, since 14. Can you do that? Or did you have a wealthy upbringing, stopping you from this truly scientific conundrum for a true experiment.

    Screw you, happy bored money grubbing entitled author and your sack of lackey’s,

    A real bi-polar sufferer with relief from Lithium and a great set of kidneys…and I know lot’s of people it worked for too, also with great kidneys,


    • Hey George “if YOU truly believe” that lithium works (and really, anything can only be as far as a belief), why don’t you convince your doctors to give their works for free and to get your meds for free. What a ridiculous comment you made.

    • George, I can’t agree with you more. Authors that write this kind of non-sense probably don’t even know what bi-polar is or have a loved one that has gone through a manic or suicidal experience. They try to do a scare tactic to buy their books and become rich. Every medication has a side effects. Thank god for medication! Where are you Joanna when they go off their medication and became dangerous to themselves or others???

    • It had two sides bro lithuim caused the worst psychosis of my life. My mania heightened to the point of psychosis and i was being raped on a regular basis by dark energy being Thats can pass through objects. No where to hide.
      Let them rag on lithuim and other can givr lithuim praise. People need to know both sides of this drug.

  8. The two times in life i havr been the most manic at that stage of my life (gradually worsened) to the point if psychosis has been after being on lithium for over 2 months at a therapeutic level. First time i felt like god and made choices i regretted at the time( i realized in the future they were actually good choices) and than quit it. I got some stabilization back for a while. at the time is was a strong manic episode.Years later after really bad episode i went on it again becuase i now attributed that my previous in the last episode i mentioned the decision was good and i did feel amazing at the time so lithuim must work lol. I went on and after 2 months i did seriosy damage to my body because of how manic i was. e.g. running 30 k and just “hyper as hell”. Also Everynight fo i was being sexually assualted be dark energy beings i could see and feel. They could pass through objects and there is no hiding from that…
    Lithium did not work for me and made matters much worse. I got put on 3 other antipsychotics to normalize myself. Not sure why the morons left me on lithuim after those epidodes. There trust in lithium had blinded them. They dont seem to pay attention to any of the facts of my reactions and whats pointed out in this article. Not sure why i listened to them… I now also have permant tremors because of this drug. Also i worked a lot if high labours jobs and could feel it go toxic in my system. I could not drink enough watet to counter act the dehydtration caused by lithuim. I couldn’t think straight. My body wad going numb, tingly and i felt on the verge of passing out. Who knows what other damage this miracle drug had done. Always research and closely moniter yourself in the moment and in refelction. I regret just blindly listening to the doctors. Careful.

  9. The two times in life i havr been the most manic at that stage of my life (gradually worsened) to the point if psychosis has been after being on lithium for over 2 months at a therapeutic level. First time i felt like god and made choices i regretted at the time( i realized in the future tthey were actually good choices) and than quit it. I got some stabiliization back for a while. at the time is was a strong manic episode.Years later after really bad episode i went on it again becuase i now attributed that my previous in the last episode i mentioned the decision was good and i did feel amazing at the time so lithuim must work lol. I went on and after 2 months i did seriosy damage to my body because of how manic i was. e.g. running 30 k and just “hyper as hell”. Also Everynight fo i was being sexually assualted be dark energy beings i could see and feel. They could pass through objects and there is no hiding from that…
    Lithium did not work for me and made matters much worse. I got put on 3 other antipsychotics to normalize myself. Not sure why the morons left me on lithuim after those epidodes. There trust in lithium had blinded them. They dont seem to pay attention to any of the facts of my reactions and whats pointed out in this article. Not sure why i listened to them… I now also have permant tremors because of this drug. Also i worked a lot if high labours jobs and could feel it go toxic in my system. I could not drink enough watet to counter act the dehydtration caused by lithuim. I couldn’t think straight. My body wad going numb, tingly and i felt on the verge of passing out. Who knows what other damage this miracle drug had done. Always research and closely moniter yourself in the moment and in refelction. I regret just blindly listening to the doctors. Careful.

  10. The suicide rate for bipolar has estimated to be as high as 1 in 5. That’s deadlier than most forms of cancer.

    Lithium has been proven to be one of the the most potent anti suicidal substances known to human kind.

    I’m not sure you understand what you are arguing at all. If you are saying it’s safer to take big pharma pills like Seroquel for 50 years I think you don’t have the least bit of understanding about what dopamine blockers do long term.

    Lithium doesn’t block anything. It controls flow rates and electrical signaling.

    If you are suggesting that bipolars should just take nothing and will have better outcomes you are going to be left a lot of unneeded suffering.

    I’d personally rather blow out my thyroid ( they can fix that ) and take my chances with kidney failure than take neuroleptics that have been shown to CAUSE BRAIN DAMAGE because it literally written in the warning label.

    • Despite claims that lithium has anti-suicidal properties, there is very little evidence to support this (see my blog on lithium and suicide which presents a detailed analysis of this evidence). I am certainly not advocating for using antipsychotics instead. I have written about and helped publicise the evidence on the association between antipsychotics and brain volume reduction. I understand that manic depression (bipolar disorder) can be a devastating and frightening condition with a high suicide rate, but my assessment of the evidence is that we cannot be confident that lithium or any oher drugs reduce the risk of relapse. They may do, but I do not think that overall the evidence is convincing. It is possible that no drug treatment is helpful and if this is the case, then obviously it is wrong to expose people to the risks of any of these drugs, however serious the disorder and its consequences.

      • Lithium is incredibly anti-suicidal, at least for me. Perhaps you want to add my account to the non-existent “evidence”. I have both OCD and BP II, I desperately need to take serotonergics but can not even tolerate 500mg of l-tryptophan. Lithium carbonate a) completely vanquished my suicidal ideation at 600mg daily. I was like, “my life is ruined, I want to jump out the window” and switched to “ok, whatever happened happened let’s move on.” and b) allows me to take serotonergics like a small dose of Zoloft which I desperately need without switching to mania at 900mg daily. All this at a concentration of just 0.57 mEq/l. I consider it a wonder drug for my case, with very little side effects (occasional double vision).

      • your logic is wrong if your viewpoint considers the actual individual with rights to a possible cure vs. the possibility of risks that are now better understood and can have precautions made such as blood levels measured. If you are suicidal or a loved one is bipolar suicidal, how can you justify blocking someone from an element that occurs naturally and might keep them alive vs. random side effects that are largely now known about and can be tested for in blood titration levels for precautions. If it’s not helping or their levels are too high, just titrate the medication down. Much of human behavior is difficult to prove… what makes another person more entitled to blocking someone from trying something that can keep them alive vs. side effects. If you could actually put that question to a test most would opt to be alive. It’s not right for you to say it’s wrong, when the person or persons loved ones can make that decision themselves. It should be discussed not forced upon when the price is perhaps someone’s life. I am bipolar. I am not a rat. It is wrong for you to decide I am incapable of understanding described side effects and ultimately making my own decisions. It’s completely arrogant of you. I was on lithium for years. It is a miracle element but does have potential deadly side effects. I am no longer on it. But I can testify that it is like no other. You can’t convince a dead person that the side effects are bad for them when they already committed suicide. It’s a very detached and presumptuous viewpoint to block an individual from a possible benefit of living vs. a side effect. You sound more like a nonhuman thing than a true humanitarian. Shame on you. You have no real personal experience except a “study”. I am not a rat.

      • Dear Sylvia,
        I just saw your subequent comment, so let me know if you want me to remove this one. I just wanted to say that I do understand the terrible situation that people are in who have manic depression/bipolar disorder, and I can understand wanting to try anything that might help reduce the risks of having a potentially devastating relapse. I would not stop someone who wanted to try lithium in this situation, and I don’t think anything I have written suggests I would do that or would somehow disapprove of someone who wanted to do that. However, I do think its important to be aware of the state of the evidence, so people can make properly informed choices.

  11. Everything is dose dependent even water can kill you. Lithium is dose and delivery mechanism dependent. Pharma use carbonate in very high “therapeutic” doses starting from 100mg in carbonate form. This dose starts side effect. Lithium carbonate (and citrate too) is very unefficient way to deliver lithium to brain due to blood-brain barier crossing. Litium in complex of orotate (vitamin B13 complex) or aspartate (amino acid) (orotate is much better) is efficient way to deliver this mineral to brain to get effect. Doses of orotate starts from 5-40mg in compare to pharma 100-300mg ions of Lithium. There Is a book that can be recommended (Veteran Suicide Breakthrough Mark Millar) which is the result of many years of research which in thousands of references describes the mechanism of lithium action not only on the brain and mental problems but also on the whole organism. Lithium is the same mineral as sodium, potassium or magnesium which must be delivered in appropriate quantities.

    • Peter, I’ve been looking, but I can’t find any evidence that lithium orotate delivers lithium to neurons and glial cells more effectively than lithium carbonate. The lowest prescribable dose of lithium carbonate is the 150 mg “pediatric” capsule. You should compare orotate and carbonate based on the amount of elemental lithium in each, because once it is in the body, the lithium ion is going to divest itself of whatever ion it’s attached to, just as will sodium and potassium. Some metals can be chelated, lead to a degree, but the sodium family cannot.

  12. Don’t EVER start lithium. In fact,my advice is to get off ALL psychiatric drugs! Try reading “The Myth of Mental Illness” by Dr. Thomas Szasz. There IS no “depression”. This is a PSYCHIATRIC LABEL. We live in a world of warped values.

    • Back in the later 60’s, when I was in graduate school in clinical psychology, the entire department laughed with derision regarding Szasz’s book. I spent 18 years working in one of the largest throughput state psychiatric hospitals in the world, treated thousands of seriously disturbed inpatients, and saw most get predictably better on medications given based on the DSM. My manic-depressive father wasn’t having “difficulties in living,” he got predictably high and crazy in September and crashed predictably in January. I have the same seasonal pattern. But unlike Dad, I took lithium faithfully from the day it was prescribed in 1986. Lithium and other medications may not agree with you, but some of us recognize a lifeline when we see it land in the water. Thomas Szasz is responsible for the deaths of many thousands whom he steered away from psychiatric treatment.

  13. Very informative and I’ve been taking Lithium for 31 years, Quetiapine for about 7. I have Hypothyroidism, secondary I believe of Lithium. I’m feeling toxic though Lithium is normal levels though Quetiapine doesn’t get tested for toxicity. I’m on 600 gram Lithium, 2 years ago 800 gram and became toxic, stopped Lithium for 2 weeks and ended hospitalised for 3 weeks, paranoid and re administered less Lithium, 700 Quetiapine.

    To add to the concoction, I stopped nicotine lozenges 7 weeks ago but even before then I’ve felt flu like symptoms, exhaustion and binging and I would like to come off all my medication and be given psychotherapy but to ask my psychiatrist will be very daunting though I must tell her how I feel.

    My life in the past was very stressful but now my life is happy and calm and I’ve stopped working as this proved too stressful, not the job as medical secretary, but the people I worked with, bad management and poor working environment.

    If you can offer any advice regarding coming off the Lithium and Quetiapine, I would greatly appreciate it.

    • The main thing to be aware of is that coming off lithium increases your risk of having a relapse if you have a diagnosis of classical bipolar disorder (what used to be called manic depression), especially a ‘manic’ relapse. So you need to reduce very slowly, but even this may not protect you against relapse, so you need to consider carefully whether you are prepared to take the risk.

  14. I say this with the most amount of respect possible…your opinion of a drug, that has saved many peoples’ lives, is kinda irrelevant and very misleading to someone who is looking for help. Of course, this is why we have trained professionals who know about the drugs and educate about the effects and risks of them. Starting your article off with one example of a person who was diagnosed with kidney failure after taking Lithium for “20 years”, is also not effective, as you provided no proof that it was the Lithium that caused the kidney failure and not something else. I did not read your whole article. It is a waste of time. As someone who has been taking Lithium for a relatively short period of time, I can tell you that’s this drug has whiteboard literally saved my life. I actually have bipolar disorder (type one with rapid cycling to be exact). I am also aware of the long term effects that the drug can have. I can be quite sure to tell you that I’d rather live until I’m fifty than to live until I’m 25, because I didn’t have my Lithium. I’m sure you’re aware of the suicide rate amongst individuals who aren’t diagnosed with the same mental illness. You are leading the thirsty away from water with this article. Very misleading.

  15. Lithium has saved my life… I tried lots of different medicines for my rapid cycling bipolar 1. I was on the edge not knowing how much more I could take. Nothing ever worked EVER. As soon as I got on lithium it completely stopped my depression. I spend many years suicidal and my mother and grandmother both died at 55 from self medicating this illness. I believe if my mother had tried lithium she would be alive today. Scaring people away from what might save them is not good. There is lots of evidence that lithium works amazing for some people, not everyone but for those it works for it really really works. I can vouch for that. I’d rather have a good life that is shortened than suffer the rest of my life the way I have suffered for the last 15 years.

    • Thanks Stephanie for your comment. I am glad you are feeling better. I am not trying to scare people off drug treatment, but I do think its important that people have all the evidence, and evidence from people with different points of view from the mainstream. then people can make properly informed decisions about whether to try drug treatment or not.

  16. My wife has taken 600 mg of lithium carbonate for 22 years and It saved her from being committed or successfully committing suicide. She is experiencing long term side effects of elevated levels of blood calcium and we are doctoring for that. We were aware of the possibility of long term effects, but found that lithium was, in her case, very effective in allowing for a stable and productive life without any “drugged feelings”, panic attacks, hand wringing or haunted depressions that, pre lithium, followed her manic periods.

  17. I’m a 76 year old retired psychologist, no private practice, worked in a very large state psychiatric facility for 18 years. It took over 3 decades on full dose lithium to give me stage 3-4 chronic kidney disease, at which point my lithium was reduced to the 150 mg “pediatric” dose. Now my kidney disease is stable and my nephrologist, my psychiatrist, my cardiologist, and my two neurologists are all happy.

    Full dose lithium can be hard on a person, but it is the best mood stabilizer available. An alternative to be considered is low-dose lithium, the pediatric capsule or lithium orotate over-the-counter. Your kidneys, your thyroid, and your cerebellum are very unlikely to suffer from such a light dose. Low-dose lithium has been shown to potentiate venlafaxine in patients who had not responded to venlafaxine alone. I am more confident than Dr. Moncrieff that lithium has unique anti-suicidal effects. At a lower, safe dose that won’t even require blood tests, why not try it?

    There are other reasons to consider low-dose lithium, because it is at the top of the list of neuroprotective substances. It thickens gray matter, it defends the hippocampus from amyloid and tau invasion, and there is increasing evidence that it prevents dementia. It is anti-inflammatory, boosts the immune system a bit, and is being investigated for anti-viral effects. It has been shown to somewhat aid recovery from stroke or traumatic brain injury.

    Other substances that are somewhat neuroprotective include CoQ10, Omega 3, statins (if you need them), and cannabidiol, the non-hallucinogenic part of marijuana. Based on all the references I have bookmarked, low-dose lithium stands out from the others. In my opinion, it should be included in multivitamins, along with magnesium, selenium, and iron.

    The author declares no conflicts of interest. I’ll never make a dime hawking low-dose lithium.

    • My sister, Fran, was diagnosed with bipolar at 22 years of age, after the suicide of our brother, Jimmy, who was 29 years of age. He suffered from depression for 3 yrs. Fran has been on Lithium since that time, she is now 62 yrs. Recently she has kidney problems, blood pressure and potassium problems plus throidoid problems. But kidney and potassium most worrying. Kidney doctor reducing lithium by degrees, because of this I see a lack of insight and no patience, which affects her social interaction with friends. Because kidneys are getting worse, doctors are considering reducing mg of lithium. Which is best, mind or body? Dreadful equation! I know I would prefer my mind to be ok. But it’s not my life, my mind. If u get this message pls email me Ann.

      • I will reply to your email, but in general it should not be necessary to reduce lithium to zero. It can be left at the 150 mg level because it will be synergistic with other medications in alleviating psychological symptoms. When lithium must be reduced, another mood stabilizer option for a depressed and irritable patient is lamotrigine. Sertraline is a safe antidepressant. Patients who faithfully take full-dose lithium over the years should also be taking amiloride every day. It will ease the kidney burden. I have just seen a research study indicating that amiloride may prevent most patients like me from veering into chronic kidney disease. It was already known to combat diabetes insipidus in patients taking lithium. So I intend to ask my nephrologist to prescribe amiloride.

        An additional factor concerning whether to eliminate lithium entirely is that low-dose lithium has been clearly shown in the literature to combat dementia. Bipolar patients who in the past have been on antidepressants with prominent anticholinergic properties, like imipramine and paroxetine are at increased risk for developing dementia if taken off all lithium. If one wants to eliminate lithium entirely, substitute CoQ10, which is available both by prescription and over-the-counter. I haven’t seen any reports that CoQ10 harms the kidneys, and it is safe, no side effects, and pretty effective.

  18. After reading through this blog, the following questions came into mind:

    1. Who is this author, and what are his/her qualifications to have the authority on this subject?
    2. What sources are used, and are they reliable?

    I’m not saying this to “diss” the author, but there is no authority that the author has to make these statements. You are not a doctor, nor are you a pharmaceutical researcher or psychologist. Yes, you have multiple sources, but plenty of these are outdated, resulting in distorted results and questionable bias already present in several of these sources (ex. critiques, reviews, etc.)

    The sources used are heavily outdated, from research papers from the 1970s, 1990s and early 2000s … for future’s sake please focus on sources published within the past 5 years since research methods have vastly improved over time to reduce discrepancies in data. It also a good idea to make sure these are peer-reviewed papers, since these are most likely to have been “as good as possible” in terms of accuracy and demonstrate new and improved methods of administering this dose. That’s why there’s research — to improve effectiveness and learn new things about the drug. Don’t want to make a mistake and support papers like the research published in 1998 stating that vaccines caused autism. (This doctor lost his medical license because of this poorly-done and poorly-concluded research and its impact, and besides this paper, all other research shows that vaccines DO NOT cause autism).

    Another thing I want to point out is that yes, lithium carbonate is toxic at some levels; that’s why people who are taking this mood stabilizer (including me) are asked by their doctors to take blood tests often to check lithium levels and making sure they are within the therapeutic range (0.6-1.2 mmol/L). Any lithium level above that WILL result in symptoms demonstrating neurotoxicity and increased kidney damage. That’s why we get the blood test — to monitor and reduce dosage should the lithium levels become to close to getting above range. We are also cautioned against taking lithium during pregnancy because (like depakote), they will harm fetal damage (Now we know thanks to trial and error and taking past research into consideration.)

    Overall, you demonstrate valid concerns regarding lithium carbonate, but PLEASE, do not make these statements to discourage people from taking this medication that could potentially change their life for the better, as it did to me. You are not a doctor or have any sort of authority to make this claim or to present any medical or pharmaceutical advice to anyone. You are free to demonstrate your opinions about the medication, but NOT to state these claims and present them as 100% true. I am writing this to protect those who read this article and later reject lithium because of this post.

      • Hey again — also want to point out that lithium is not for everyone. It may work for some, may not work for others. I’m not saying lithium is 100% effective. Everyone is different.

    • Just to be clear, I am a doctor and I have worked for 28 years with people with serious mental disorders. I am also an academic and I have spent almost as long studying the research on drugs treatments in psychiatry, and conducting some too. I focused on the research that is believed to have established the effectiveness of lithium. There are actually very few placebo controlled trials have been conducted since the 1990s, and they are not fundamentally different from earlier ones in design or results.

      Anyone who is considering taking lithium or another drug for manic depresssion will hear all about the proposed benefits, but is not likely to hear about the problems with the research. They may also be given a false impression of the safety of lithium. Monitoring does not, in fact, prevent toxicity, which can occur at normal levels and kidney damage also occurs at normal levels too. I understand the desire to try something if you have experienced manic episodes, which must be very frightening. I am not saying you shouldn’t do this, although I think there are safer options than lithium (although everything comes with adverse effects of some sort, of course). But I think it is important that people have a complete picture of the evidence before they do so, and are not mislead into thinking that it is more convincing than it actually is.

      • What sort of “toxicity” occurs at “normal” (therapeutic) levels? I agree that a few patients will experience unacceptable side effects, such as brain fog, rash, or tremor, at therapeutic levels, but why call that toxicity? Bad side effects are just that, they don’t indicate the sort of damage to heart and brain when lithium blood levels go above the “therapeutic” range and engender “toxicity.”

        Patients who tolerate lithium well should be kept toward the low end of the therapeutic range. If I were a psychiatrist, I would add another medication to boost stability, rather than using the higher end of the range to achieve stability.

        I read that a new skin-stick-on device may be available soon so that patients can monitor lithium levels at home. Maybe next we’ll see a Smart Watch that monitors lithium, tells a patient when levels are too high or too low, and snitches to the doctor when noncompliance occurs.

    • Just commenting on a detail. Lithium is *not* as teratogenic as depakote. Probably almost an order of magnitude less so. One of the women in my support group was grateful to be pregnant for the first time in her late 30’s, but her doctors threatened to abandon her if she did not terminate the pregnancy. She gave in. They could have dropped her lithium level way down and have kept her stable with certain antipsychotic medications which can also hold down mania.

      It used to upset me greatly when the psychiatrists at our hospital stabilized young women on depakote, an inferior mood stabilizer, just because it was easier to manage than lithium in the first week of a hospital stay. In addition to being more dangerous to a foetus, depakote can interact badly with a multi-follicular condition present in some women.

  19. Again, based on my own experience, I urge patients on lithium to get their blood levels checked regularly. Even once you and your psychiatrist feel you have established a predictable baseline, and you’re cruising along confidently year after year, changes associated with age may put your kidneys at risk. My psychiatrist and I got lazy and failed to keep up with my lithium levels. I had dropped salt intake somewhat, and had increasing problems with low blood pressure. Lower sodium contributed to high, somewhat toxic, lithium levels which caused peripheral neuropathy and balance problems that may have been due to cerebellar damage. On learning that I had developed chronic kidney disease, I immediately dropped lithium intake from 1200 mg to 150 mg, and within 2 months, the peripheral neuropathy disappeared and my balance improved to near normal.

    My kidney doctor recommended a fairly high sodium intake to improve my blood pressure, and that also contributed to keeping my lithium level down.

    My nephrologist is just a block away from my psychiatrist. I suggested to my psychiatrist that having all patients on long-term lithium see a nephrologist every year or two would save some kidneys. He doesn’t agree, but it was his and my failure to get lithium levels checked at least once a year that degraded my kidneys. Some degradation of kidney function will occur in *all* who take full-dose lithium, and about 30% will develop chronic kidney disease. While research shows that very few lithium consumers will progress to kidney failure and dialysis, why get kidney disease in the first place?

  20. Relapses are caused by the disorder. This blog post is a giant face palm. People can experience kidney failure without a known etiology. The majority of people that take Lithium for long periods do not experience kidney failure. I don’t know why I’m even commenting on this reductive hypothesis of this blog post. Estimates have shown up to 90% of patients relapse several times whether medicated or not medicated. Are you even a doctor?

  21. I have Bipolar Disorder I with multiple suicide attempts before diagnosis. Lithium saved my life and all of my organs are in perfect working order, 3 years 1200mg daily later. Sometimes it IS worth it

Leave a Reply

Fill in your details below or click an icon to log in: Logo

You are commenting using your account. Log Out /  Change )

Google+ photo

You are commenting using your Google+ account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s