[Lithium orotate 5mg and 120mg pills are inexpensive on Amazon.]

Lithium 150 mg per day is advisable for anyone with a psychiatric disorder (especially for bipolar depression, or someone with a first degree relative who developed Alzheimer’s before y.o.), or for anyone particularly worried about Alzheimer’s. It is prudent to discuss it with your primary care doctor to be sure your kidneys are not compromised (via creatinine level from standard blood panel).   Show your PMD the references here.

BOTTOM LINE on lithium dose for Alzheimer’s prophylaxis. 

• Lithium orotate 5mg once a week almost certainly reduces the risk of Alzheimer’s—or 1mg per day (available able at Essenta). Areas of the world with considerable amounts of lithium in the drinking water have significantly less Alzheimer’s (and less suicide). This water provides 0.3mg/day of lithium to those drinking it supposed to. 5mg/week is ~ 0.7mg/day double what it is in water that has a high concentration of lithium.  [Lithium orotate 5mg is not by prescription. One can find it in health food stores or on internet for ~$10 for 120 pills–a 2+ year supply.  Prescription lithium (150 mg, 300 mg, 450 mg, and 600 mg pills) comes as a different salt, lithium carbonate. There is no difference between lithium orotate and lithium carbonate. Both end up with lithium floating free in the bloodstream.
• 5mg per day or 150mg once a week are preferable. They are extremely low doses, and preferable to 5 mg per week, I believe.   Virtually no one has side effects on these doses.
• I urge a higher dose– 150mg per day– for anyone with a risk factor for Alzheimer’s—e.g., family history of Alzheimer’s, or a personal history of a mood disorder—even if it is just very mild depression. Depression and other mental illnesses—especially bipolar depression—increase Alzheimer’s risk dramatically.   Lithium 150mg/day (a low dose when compared to 900 to 1800mg used  in Manic Depression / Bipolar I) gradually helps depression as the months and years pass, in my experience.  Blood tests are not necessary at 150mg/day, unless the kidneys are compromised. [Lithium usually only causes kidney damage when taking ≥ 900mg/day for decades. Routine lab tests always include a creatinine level, a measure of kidney function.  Creatinine should be ≤ 1.2 in an adult.   Someone over 75 y.o. might take only lithium just 2 or 3 times a week—consult your doctor.) 

 

ADDITIONAL INFORMATION:

ALZHEIMER’S RISK: It is hard for me to believe, but competent sources say that 1% of people who are 60 years old have Alzheimer’s, and it increases by 1% per year. At age 90 y.o. the cumulative risk of Alzheimer’s is 30%.  Perhaps only 10% of 90-year-old people currently have Alzheimer’s, but there is another 20% who have already died of the disease, since it kills people within five years. If one has a family history of Alzheimer’s, the risk is significant when their onset was <70 y.o. .  Alzheimer’s being so common, everyone becoming older than, say, 75 y.o. is at considerable  risk—family history or not.   There are a number of other substances that seem to reduce Alzheimer’s risk (vitamin E, vitamin D, fish oil, et al).  Lithium is by far the most effective.   Many physicians are now taking it.  Two of my physicians—one takes 1mg/day and the older one takes 70mg/day.   Who knows what the right dose is?

MORE ON ALZHEIMER’S and LITHIUM PROPHYLAXIS, WITH REFERENCES: 

• Lithium 5 mg once a day is no doubt enough to reduce risk of Alzheimer’s. Even taking lithium 5 mg once or twice per week should be significant prophylaxis. [Purchase lithium orotate 5 mg from health food store or the Internet.]  I give most of my patients 150 mg a day, since most of them have a depressive diathesis—which 150mg can help, if not now, then eventually.

Statistics on Alzheimer’s are hard to believe, but apparently true. Considering all the patients I have had who developed Alzheimer’s, and all my current patients who are dealing with a first degree relative with Alzheimer’s, these statistics ring true. 1% of people who are 60 years old have Alzheimer’s. The rate goes up 1% per year. [Ned Nunes wrote this somewhere.] At 90 years old the cumulative Alzheimer’s rate is 30%. Maybe 10% of 90-year-old people currently have Alzheimer’s [I am guessing], but another 20% of victims will died before 90 y.o..  Alzheimer’s is fatal in ≤ 5 years.

Prophylaxis of Alzheimer’s with lithium is very important in people with a mood disorder.  Mood disorders and other psychiatric disorders significantly increase the risk. People with Manic Depression (Bipolar I Disorder) are at extreme risk.  One third of them develop Alzheimer’s if on no lithium, whereas those on some lithium have a risk of about 1/20.[1]

• To anyone who has suffered from any depression, I recommend lithium 150mg/day–assuming the kidneys are not severely compromised.  This dose does not require blood monitoring and rarely has detectable side effects.  As we age the side effects of lithium may increase.  People ≥ 75 y.o. may only tolerate lithium every other day or less.  If you have compromised kidneys, talk with your nephrologist before using it.
• The doses of lithium used for Manic Depression (Bipolar I Disorder)– ~900 to 1500mg—can significantly damage the kidneys, usually only when taken for 3-4 decades.
• For people with no history of depression, it is a toss-up whether to use lithium orotate 5mg/day or lithium carbonate 150mg once a week.  
• Lithium 1mg/day reduces the risk of Alzheimer’s– based on a good study[2], and based on areas of the world where there is a lot of lithium in the drinking water
• Since even lithium 300mcg/day (0.3mg per day) has been shown to prevent the progression of Alzheimer’s[3], it is likely to be prophylactic of Alzheimer’s. This dose is approximately the daily intake in areas with high levels of lithium in drinking water– areas with less Alzheimer’s and less suicides[4].    Lithium orotate 5mg once a week is double the amount in this study.

            DEPRESSION AND LOW DOSE LITHIUM— Although 150mg/day often helps depression, many need more—e.g., 300 to 600mg per day–for optimal antidepressant effect.  Interestingly, only low doses have an antidepressant effect.  High doses—e.g., doses of  >900mg, such as are used in Manic Depression/ Bipolar I Disorder– do not help depression. Combined with minimal side effects, low dose lithium is a different medication then high dose lithium.

• In only a few years (as of 5/13/2018) I have 50 patients who had a significant antidepressant effect on 150mg /day in <2 week None of them ever seemed to be placebo responders.  Most of them expected nothing positive from low dose lithium.
• A few other patients seem to have had “delayed” response. It is, of course, impossible to prove that lithium caused improvement months after it was started.  Some I have known decades had their baseline improve—or the bottom of their dips is more shallow.

I HAVE EVEN HAVE HAD 3 PATIENTS WHO HAD IMMEDIATE ANTIDEPRESSANT EFFECT AT <150MG PER DAY:

Patient #1:  150mg once a week:  a 75 y.o. woman with recurrent MDD’s and MCI (mild cognitive impairment) who developed chronic MDD as she aged.   [I believe she is bipolar spectrum, but any highs were long ago).  She she lost the benefit on 150mg/week, and regained it increased it to 2 or 3x/wk. 

#2: 150mg twice a week.  40 y.o. woman with severe rapid cycling Bipolar I Disorder who I have treated her over a decade.  Initially, she could quickly cycle into a psychotic mania for two hours and have no memory of it. It took half a decade, with the invaluable help of Rabbi Eliezer Weichbrod, to reasonably stabilize her on clozapine, et al–and later transition to other atypicals. The last few years she has appeared rather normal, and had no observable cycling.  Complete euthymia did not occur until a few summers ago when 150mg twice a week was added.  [She had been on 300 to 900mg/day in the past.]  On 150mg mg 3x/wk she had severe tremor.  On 1x/wk she has mild, but significant, chronic depression.  She says she was never completely normal until lithium 150mg two times a week.  At the time she said, “I was always felt manic and depressed at the same time, and now I am completely normal”.

#3: 150mg every other day–~50 y.o. woman with chronic depression, bipolar spectrum.

ADDENDUM— There is an excellent book every psychiatrist—and many patients–should read: A Spectrum Approach to Mood Disorders: Not Fully Bipolar but Not Unipolar – Practical Management (2016), by James Phelps, M.D. He especially advocates the ultimate goal of using same combination I commonly use for bipolar spectrum disorders: lamotrigine and low dose lithium.

He underestimates the usefulness and antidepressant effect of Depakote and of TMS (Transcranial Magnetic Stimulation).

The major goal of his website (www.PsychEducation.org) is helping bipolar spectrum patients [which includes Bipolar II, as well those with atypical symptoms] come to terms with the unfortunate word “bipolar” and understand their illness. I have had a few patients who were extremely pleased at reading it.

Manic Depression was renamed Bipolar I Disorder since there was so much stigma attached to the word “manic”, the root of maniac.  Soon the stigma shifted to the word “bipolar.”   Most of us have some acquaintances, relatives, or neighbors are obviously mentally ill— periodically bizarre, uncontrolled behavior and multiple hospitalizations.    It is understand that bipolar spectrum and Bipolar II are extremely upset by being labeled bipolar.

REFERENCES:

[1] Bipolar I Disorder patients have a 1/3 incidence of Alzheimer’s!   But if they are on lithium, the incidence is about 1/20, about the same as the rest of the population. Lithium and risk for Alzheimer’s disease in elderly patients with bipolar disorder, Paula V. Nunes, et al British Journal of   Psychiatry, 2007.”

2 A 2011 study in British J of Psychiatry demonstrated that giving lithium 1mg per day reduced the risk of Alzheimer’s in older patients with MCI (mild cognitive impairment)—MCI is a diagnostic group with a high conversion rate to Alzheimer’s.  “Dosages to treat mania are usually 900 to 1500 mg/d. However, in minute (homeopathic) dosages as low as 1 mg/d, lithium has been shown to prevent progression of amnestic mild cognitive impairment to full dementia.¹² This interesting observation suggests that lithium not only induces neurogenesis and increases gray matter volume,¹³ but may be neuroprotective against amyloid neurotoxicity. The effects of very low doses of lithium in depression and schizophrenia have not been studied yet.”       Forlenza OV, Diniz BS, Radanovic M, et al. Disease-modifying properties of long-term lithium treatment for amnestic mild cognitive impairment: randomized controlled trial. Br J Psychiatry. 2011;198(5):351-356.

3 Microdose Lithium Treatment Stabilized Cognitive Impairment in Patients with Alzheimer’s Disease  Andrade Nunes, Marielza; Araujo Viel, Tania; Sousa Buck, Hudson    Source: Current Alzheimer Research, Volume 10, Number 1, January 2013, pp. 104-107(4)

4 Areas of the world that have considerable amounts of lithium [yet <1mg/day] in the drinking water have significantly less Alzheimer’s and less suicide, compared to contiguous areas. 

• In addition, a high level of lithium in drinking water sensitive seems to decrease the incidence of crimes, suicides, and arrests related to drug addictions.   Schrauzer GN¹, Shrestha KP.,  Biol Trace Elem Res. 1990 May;25(2):105-13.

 

 

 

[1] areas of the world that have high amounts of lithium [yet  <1mg/day]  in the drinking water have significantly less Alzheimer’s and less suicide, compared to contiguous areas.  E.g., : Lithium in drinking water and the incidences of crimes, suicides, and arrests related to drug addictions.   Schrauzer GN¹, Shrestha KP.,  Biol Trace Elem Res. 1990 May;25(2):105-13.

 

A 2011 study in British J of Psychiatry demonstrated that giving lithium 1mg per day reduced the risk of Alzheimer’s in older patients with MCI (mild cognitive impairment)—MCI is a diagnostic group with a high conversion rate to Alzheimer’s.  “Dosages to treat mania are usually 900 to 1500 mg/d. However, in minute (homeopathic) dosages as low as 1 mg/d, lithium has been shown to prevent progression of amnestic mild cognitive impairment to full dementia.¹² This interesting observation suggests that lithium not only induces neurogenesis and increases gray matter volume,¹³ but may be neuroprotective against amyloid neurotoxicity. The effects of very low doses of lithium in depression and schizophrenia have not been studied yet.”       Forlenza OV, Diniz BS, Radanovic M, et al. Disease-modifying properties of long-term lithium treatment for amnestic mild cognitive impairment: randomized controlled trial. Br J Psychiatry. 2011;198(5):351-356.

3 Microdose Lithium Treatment Stabilized Cognitive Impairment in Patients with Alzheimer’s Disease  Andrade Nunes, Marielza; Araujo Viel, Tania; Sousa Buck, Hudson    Source: Current Alzheimer Research, Volume 10, Number 1, January 2013, pp. 104-107(4)

4 Areas of the world that have considerable amounts of lithium [yet <1mg/day] in the drinking water have significantly less Alzheimer’s and less suicide, compared to contiguous areas. 

• In addition, a high level of lithium in drinking water sensitive seems to decrease the incidence of crimes, suicides, and arrests related to drug addictions.   Schrauzer GN¹, Shrestha KP.,  Biol Trace Elem Res. 1990 May;25(2):105-13.