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.

87 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.

      • Before I was put on lithium in 1986, I was a bit “high” through autumn, and then abruptly crashed in late winter. My father, a type 1 (I am a type 2) showed the same pattern. When interviewing patients for possible bipolarity at the hospital, I included 2 questions. First, “Are you a morning person, or a night person?” Bipolars are night persons, they feel their best in the evening, and may even stay up late. I also ask what months in the year one feels the best. Bipolars (unlike seasonal affective disorder) tend to feel best in September through the end of the year. Depression occurs in late winter and can last into August, as it did in my case.

        Obviously when a full-fledged manic episode has been observed, such questions may not be needed.

        I would recommend at least a little bit of lithium for bipolar patients. Even if they cannot tolerate 1200 mg, the 150 mg “pediatric” dose should be without side effects. Even such a small dose has important neuroprotective effects, and there is now evidence that it reduces risk of Covid19.

    • 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???

      • Came here to say exactly this. To anyone reading this, before you buy into this nonsense look into the biology of bipolar, eg ANK3 mutations that ultimately affect Lithium transport in the brain. Lithium is literally a lifesaver for many bipolar people and there is plenty of scientific literature on the biological differences between responders and non-responders. In fact there are even lithium responder families, in which a generational line of mood disorders can be managed with lithium. It’s not a risk free drug but believe me, unmedicated mania is not risk free either 🙃

    • 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.

    • I 2nd this opinion. It works for some & doesn’t for others. It does for me and I don’t feel your article addresses those who it does work for. Please don’t use scare tactics – BiPolar is hellish and I would hate to see someone refuse to take it without ever trying it because of your paper

    • My reply to George would be the same as my reply to Shannon. I would happily make my books available free, but I am bound by copyright law, and the publisher has to make a living. They are available via the Palgrave website ( and, PCCS Books website (A Straight Talking Introduction to Psychiatric Drugs: and Amazon.

      • Really I don’t want my response posted I just simply completely disagree with your ideas as you seem very detached from the plight of mentally ill and focused too much on data of side effects, ignoring individual testimonies where nothing else helped. I find your conclusion impartial, detached and focused on generalizations and a logic that pertains to generalizations. When you are desperate for help for yourself or a loved one these generalizations are arrogant, presumptive and very hurtful. Humans are not all the same and just because the data shows otherwise sometimes does not negate the logic that perhaps your data is inconclusive and lithium does in fact help in many other cases plus many undocumented cases. The things you have concerns about can be monitored. It is that simple. Please research something more helpful. Your study is as hurtful as your presumptive conclusions. Your conclusions are inconclusive and maybe the limitations of a study in fact mean it’s too complex pigeon hole in a study. There are a multitude of health benefits that aren’t even understood about lithium. The benefits ARE studied as you can just pull up article after article. So I must say I too think you preach because you have monetary gain as your motivation.

  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.

      • My doctor talked to me about the benefits and possible issues with Lithium. I made the final decision whether to take Lithium and it was a decision that was well-informed. My doctor is good like that.

    • 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

  22. Yall are all stupid if you think lithium doesn’t work for at least some people with manic depression. I take 900mg a day and I don’t experience any side effects of toxicity because I drink enough water. I have Bipolar 1 and experience wild mixed episodes where my anxiety will go through the roof. Ever since I started lithium I’ve been able to get out of the house without my husband right next to me. Sometimes I couldn’t get out of the house or even out of bed because it was so bad.

    Now I’m exercising, doing chores, eating better, getting out of the house, going on walks, and not over sharing with people or making terrible decisions. Plus I don’t have to feel like my brain is on fire and my body isn’t shaking with fear from the mania/depression existing simultaneously.

    Lithium obviously isn’t for everyone, but that’s my take on it. It works for me.

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  24. What about ionic lithium (I.e. lithium dissolved in water) at what dosage, parts per million, is it likely to start helping, and at what dosage is it likely to require other supplements/medication to minimize kidney impact?

    • Full dose lithium does wear down the kidneys. But low dose, the 150 mg “pediatric” capsule will not. Significant protective benefits at very low risk. Anyone at risk for Alzheimer’s should be on it. The neuroprotective benefits of lithium are very strongly supported by research.

      And Moncrief, good grief! When are you going to comment about CBD? It’s only downside is that it is a blood thinner, but most of us old folks need our blood thinned anyway. CBD should be stopped before surgery, but can be resumed when healing is sufficiently thorough. Cheap, safe , only side effects are beneficial…What’s not to like?
      Another anti-dementia substance to consider is CoQ10, which boosts mitochondrial function in the heart. Also cheap, safe, effective, very low side effects, just a teensy bit of blood thinning.

  25. If someone takes ionic lithium (low dose dissolved in water) what symptoms and diagnostics should they monitor to know when to reduce ionic lithium intake?

  26. I am a former user of lithium. I am only 46 years old and will not be alive within a year or so DUE to the irreversible disease that lithium use has given me. At 34 years old after being on lithium for 8 years with mostly mania, and and a drop of mild depression, I decided to slowly stop the drug to see if I really needed to be on it. A few months prior to stopping, I noticed that I was becoming fatigued, which I never had before. I wasn’t depressed, just really mentally tired. Side note, also at that time I had already had 4 kidney stones in the past 6 years. 1st stone after being on lithium for under 2 years. At age 36, my fatigue had turned to exhaustion and ooops!! another kidney stone and I can’t walk a mile at a good clip, let alone jog, (jogging ended when the mild muscle fatigue began). Projects around the house stopped. My wife really was happy about that! Long story short a few years ago I was diagnosed with parathyroid disease, brought on by lithium use. Surgery did not correct the problem. Parathyroid disease brought on by lithium use is not correctable, even after stopping the drug. P.S. I now have osteoporosis due to the parathyroid disease. I am a 46 year old man who has broken 2 toes, 3 fingers and was told NOT TO FALL or I may break a hip. Thank you to the doctors who never warned me of this. I am always resting or sleeping, almost all day and night. Every now and then I have a little energy to get to the bathroom and shower and back into bed. I have 2 children who I am not able to enjoy and it breaks my heart that they have to see me like this. I won’t be around for any grandchildren. Parathyroid disease, if not cured has a survival rate of 22-24 years. I estimate the disease started after being on lithium for a year or two.

    • Yeah, well, after decades of my lithium levels being low, causing me and my shrink to stop checking, they veered into the toxic zone, giving me chronic kidney disease and leaving me a bit unbalanced (ha ha) from cerebellar damage. So on learning of the problem, I dropped my lithium use to the smallest level, the 150 mg “pediatric” capsule, and then I slowly started to get on the mend. A high salt diet and propranolol corrected my low blood pressure.

      I take Prolia shots every 6 months for osteoporosis. I haven’t lost a bit of height. As for your parathyroid disease, I recommend that you start taking CBD (cannabidiol), the miracle medicine, available everywhere. It will ease your pain (physical and mental) and save your brain! Maybe it will cure your parathyroid disease. After a year on no lithium whatsoever, I had no parathyroid signs whatsoever. On CBD, I had no more migraines, only a small increase in bleeding tendency. Most of us old folks need a blood thinner anyway.

      I’ve seen Dr. Moncrrieff diss lithium for reasons that I, as a medical psychologist, find unconvincing. Soon she will be telling us how CBD is not proven to do anything for anyone. But I have seen the evidence for low-dose lithium’s neuroprotective effects since 1990. It thickens gray matter, and clears amyloid and tau out of the hippocampus. CoQ10 is also neuroprotective for old folks like me. It is a natural body constituent that becomes lower in level as we age. CBD is so anti-inflammatory, so anti-anxiety, so antidepressant, and great for migraines and hangovers that its use is sweeping the nation. Big Pharma and the FDA are fighting back, but they are getting scratched trying to put the cat back in the bag.

      So I recommend that you get some CBD and try it. It only takes a little. And start taking Prolia shots. Soon you will be on the mend and playing with your children. Oh, and CBD is also a sleep promotor. Enjoy!

      My mother and two of my wife’s relatives died of Alzheimer’s, so we both take CBD. I take CoQ10,

      • Thanks for responding. As for Prolia, because I don’t have regular osteoporosis, those drugs won’t work. If the bone loss is from parathyroid disease, the osteoporosis drugs would make it worse. Many doctors, unfortunately push those drugs regardless, but I’ve done my research and it is a huge mistake to take them if parathyroid disease is the culprit.

      • I was on high-dose lithium for almost 30 years, and showed no sign of parathyroid disease whatsoever. And I never showed any signs of dementia, even though my mother, and two of my wife’s relatives, died of it. I have followed lithium research since I was put on it in 1986, and it is clear that, taken in low doses (it is cheap, safe, and effective. As for CBD, it is highly anti-inflammatory, antidepressant, anti-anxiety, and quite likely will turn out to be a better mood stabilizer than lithium. I worked for 18 years as a neuropsychologist at a large state hospital, the Hartsfield-Jackson Airport of psychiatric hospitals, and the only reason I saw for a decrease in lithium use was that they were anxious to discharge patients as soon as possible, so they used Depakote, which worked faster. But Depakote has more serious side effects, especially for women. Taken in excess, it can also cause cerebellar damage. A friend in one of my bipolar support groups kept forgetting that he had already taken his Depakote, became more and more foggy, and ended up with permanent brain damage.

        So take some CBD. Even if you are sure it will do no good for your parathyroid disease, you will worry less about it.

      • Fortunately, most people don’t get parathyroid disease, but it can happen and does. Just look up lithium induced parathyroid disease. It could happen at 2 years or at 30. Everyone who decides to go on lithium should have mandatory parathyroid, blood calcium and alkaline phosphatase levels checked every few months. If any of these #’s are off, lithium should be stopped. Also a bone density scan should be performed before the start of lithium and 2 years later. This disease can definitely happen. I am off lithium for quite some time and my kidneys are healthy, but I had several kidney stones, calcified, meaning they came from my bones, parathyroid disease. Please don’t try to push CBD on this. The parathyroid glands dictate how much calcium should be in the blood. When they are overactive, they signal the bones to release calcium into the blood stream. Over the course of time a person gets osteoporosis. Don’t sugar coat this. A 20 year old taking lithium, may be dead in 25 years. It is not worth the risk.

      • One more comment, I’ve been off lithium for years and my parathyroid level is higher then ever. One of the top parathyroid specialists said to me that even when lithium is stopped, the parathyroid disease continues. Most people who take lithium will not get parathyroid disease, but the longer you are on lithium, the chances increase. Never listen to doctors when they say “the rewards outweigh the risk”. CBD oil is not a cure to regulate your parathyroid glands. These glands when not in sinc, give a person dementia like symptoms, broken bones and eventual death. It doesn’t always have to be long term use. My doctor said he has seen it with young people on lithium for just 4 or 5 years. Lithium is a drug that is NOT being prescribed as much because of the serious long term side affects.

      • Wrong again! I recall that my nephrologist was treating me for parathyroid disease. Not that here was more than a teensy little bit of evidence for it. Lithium is still being used often by psychiatrists in both hospitals and in private practice. My own shrink, whom I have known for years, still prescribes it. Some wear on the kidneys is to be expected, and some people don’t tolerate the tremor, or the loose stools. Amiloride will reduce the kidney problems. As I was on lithium for almost 30 years, and then went toxic, how do you explain that I did not get a whopping case of parathyroid? One reason lithium is not used as much is that Big Pharma salesmen and new drugs for which there is very little evidence that they are any better.

        I got my bachelors at MIT , my Ph.D. at Penn, spent the last 18 years of my career observing the effects on Lithium and other treatments, some of them much nastier, on patients in the hospital and in the community, and in myself. I have no idea why your parathyroid disease was so bad, when but I assure you that, when cells are dying, low-dose lithium is what you should be trying. And pay attention, when I said that CBD will ease your pain (physical and emotional) and save your brain, I was mainly suggesting that you needed it to reduce your anxiety. Later on, I think it will prove to be a safer mood stabilizer than lithium. I’m on only a tiny bet of CBD, I get no more migraines, and I’ve ditched the last bit of my venlafaxine with no recurrence of depression.

        While I read up on parathyroid disease in Wikipedia and Mayo Clinic, you might google the NYT articles, “Should we all take just a little bit of lithium?” and CBD, can it really do all that? You do your own homework, and I will do mine.

      • Hi Gary,

        Your comments are very insightful!! My daughter of 16 years started a Bipolar I with a rapid-cycle feature (Ultradian – weekly cycle) two months ago. It started with several weeks of initial depression followed by 1 week of hypomania, and then she’s been going through the 7th rapid cycle of major depression with suicidal ideation and full mania w/ severe paranoid delusions (most during manic), auditory hallucinations (most during manic and now during depressive episode), and homicidal ideation(1day only). You may not believe it, but due to a severe lack of adolescent pdoc shortage on where I live, I had to step up and did all these research to classify her illness (later confirmed by her pdoc) and started self-medicating her with CBD w/0~0.03% THC (250 – 300mg/day now) and Lithium orotate (50mg elemental lithium/day). She’s been on CBD for 3&1/2 weeks and 2&1/2 weeks on Lithium orotate. I see major improvement during the depression phase with suicidal thoughts, but during her manic phase, her lack of sleep fuels the worst symptoms of mania described above. Do you have any suggestions as to what we can do to regulate her manic episodes? She has anosognosia so unless she is fully convinced that the drug/Vitamine does not have harmful side-effects, she will refuse to take them. We forced to have her take a 100% natural sleeping pill once, but she refused to take it again and ended up lying to us that she has been sleeping soundly in her last manic episode. Thanks in advance for any insights you may be able to share.


  27. I did not see your last post, sorry.

    I will end this conversation regarding lithium and parathyroid disease. I have it, it is getting much worse and I don’t have depression and very little mania and not taking ANY med’s. HUGE mistake folks to try lithium with the chance of getting irreversible parathyroid disease. This drug can also screw up your kidneys. As upsetting and horrific bipolar disorder can be, don’t reach for the lithium. Research other alternatives. PS. Many years ago lithium was taken off the market for serious side effects. Big pharma was making a ton of money off the drug and it was put back on the market, but more and more doctors are saying goodbye to Lithium. If your doctor won’t, then you say NO!

  28. Hi Gary,

    Your comments are very insightful!! My daughter of 16 years started a Bipolar I with a rapid-cycle feature (Ultradian – weekly cycle) two months ago. It started with several weeks of initial depression followed by 1 week of hypomania, and then she’s been going through the 7th rapid cycle of major depression with suicidal ideation and full mania w/ severe paranoid delusions (most during manic), auditory hallucinations (most during manic and now during depressive episode), and homicidal ideation(1day only). You may not believe it, but due to a severe lack of adolescent pdoc shortage on where I live, I had to step up and did all these research to classify her illness (later confirmed by her pdoc) and started self-medicating her with CBD w/0~0.03% THC (250 – 300mg/day now) and Lithium orotate (50mg elemental lithium/day). She’s been on CBD for 3&1/2 weeks and 2&1/2 weeks on Lithium orotate. She is doing better than before when it comes to depression, but I see major improvement during the depression phase with suicidal thoughts. During her manic phase, her lack of sleep fuels the worst symptoms of mania described above. Do you have any suggestions as to what we can do to regulate her manic episodes? She has anosognosia so unless she is fully convinced that the drug/Vitamine does not have harmful side-effects, she will refuse to take them. We forced to have her take a 100% natural sleeping pill once, but she refused to take it again and ended up lying to us that she has been sleeping soundly in her last manic episode. Thanks in advance for any insights you may be able to share.


    • I would try to up the CBD. It may turn out to be a better mood stabilizer than lithium. This is certainly NOT a good time to hospitalize her. I have just seen a paper supporting my suspicion that CBD protects against the virus.

  29. Joanna
    I’m bipolar and was on lithium for 15 years, had four episodes on lithium. I could tolerate it ok. But since I took a contraindicated nsaid in September, I developed an adverse reaction to the lithium. I have severe emotional blunting and cognitive dulling. I know it’s the lithium because my psychiatrist did two reductions which lessened the blunting. Now I managed to get the psychiatrist to reduce further to 500mg for a month then down more and get put on valproic acid. I’m already thinking of just staying off a so called mood stabilizer. What really scared me is that the psychiatrist asked me to think about accepting the emotional blunting at 400 as the price to pay for stability. That is anathema to me. I want to feel normal. I’m on olanzapine 10 mg as well. Well and truly entangled into modern psychiatry. My mother is also bipolar but quit lithium 25 years ago and hasn’t had any episodes or meds. She attributes it to getting over the menopause. I had the menopause last year. I’m glad the psychiatrist is reducing my lithium slowly. I may even go med free if he gets me off it. But I am really frightened of having a manic episode. I don’t want to put my family through my insanity again. It’s so traumatic for everyone. I suppose I just don’t know what to do. If I even have a bad night sleep I could be in trouble.

  30. Dear Tracey,
    I wonder whether you would have had any more than four episodes of illness over the last 15 years if you had not been on medication. As an individual you can’t know, but this is why I draw attention to the research and its flaws (the discontinuation design), because I don’t think we have clear evidence that lithium or any other mood stabiliser does actually reduce the risk of having an episode. If you do decide to come off medication altogether, or even just stop the lithium, be sure to do it as slowly and carefully as you can, because it does seem that discontinuing long-term lithium, and possibly other long-term treatments too, increases the risk of relapse in the months following discontinuation. I can understand what a difficult decision it must be for you, and how scary the prospect of having another manic episode must be. Best wishes for whatever you decide.

    • I had the same amount of manic episodes (6 in total) and roughly time between them as my mum who wasn’t on meds. So I really doubt the efficacy of these drugs as maintenance meds. The antipsychotics are necessary for psychotic episodes in hospital. But taking antipsychotics for maintenance is tough going. I’ve gone along with psychiatric treatment with virtually no explanation of efficacy at the start. It was just assumed I’d consent. And I did. Much to my surprise, my psychiatrist is taking me off lithium to put me on valproic acid. I just want to get off lithium more than anything because of the emotional blunting which is so severe and inexplicable. No one else seems to have had this side effect. The psychiatrist told me he’ll put me back on 800 lithium if I get sick again. That would be dire meaning more emotional blunting again and cognitive dulling. I have to focus on each day and staying well tapering off 600 gm lithium for the next six months or more. Thanks for your best wishes.

    • Joanna
      My psychiatrist is reducing my lithium because I have very severe emotional blunting and cognitive dulling, with a constant sensation of stress. I just wanted to know whether you were familiar with lithium causing such side effects. I was on it for 15 years but only developed side effects from September.

    • Joanna,
      This has nothing to do with lithium. I took an nsaid called vimovo back in September for three days and ever since I have no emotions, poor concentration and poor memory. No one seems to believe that such a drug would have an effect. I read somewhere you said a drug could be given to a person and alter them completely.

  31. Dear Tracey,
    I don’t know much about Vimovo, but the data here suggest it can produce some neurological effects including poor concentration. I think studies rarely look for suppressed emotions, so the fact this was not reported does not mean it did not happen
    Anecdotally, for most people these drug induced ‘legacy’ effects will improve with time, so try and keep hopeful.
    Best wishes,

    • I was on therapeutic dose lithium for 30 years, until I got chronic kidney disease. During that time, I got minor bacterial infections, but no colds or flu in spite of not bothering with flu vaccines. Research confirms that lithium boosts the immune system in favorable ways. CBD (cannabidiol) does also, and has other benefits such as being somewhat antidepressant, anti-anxiety, and anti-inflammatory. A combination of low dose lithium and CBD might protect against the Covid virus.

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  33. I’m sorry but this is ridiculous. Myself, and millions of others have had life saving benefits from Lithium use. I really hope you are not a psychiatrist. I have zero side effects, and I haven’t had a manic episode since I was prescribed. My entire life has changed for the better. The entire reason Lithium is generally the first line of treatment is due to its minimal side effects when compared to other bipolar meds. This kind of article is damaging to the bipolar community.

    • I am sorry you feel like this. As I have said in reply to others here, I am presenting my interpretation of the research on lithium and its limitations because I think it is important for people to know that the idea that lithium is an effective prophylactic is not proven beyond doubt. I am glad to hear you have no side effects, but many people do experience these.

  34. A very good argument on the pros and cons of lithium. Having been on lithium myself for about 30 years I can concur with this argument, having the same fears as the author. However unless a safer alternative therapy is found I fear I may never come off lithium – the stakes are too high!

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