MY RATIONALE FOR USING LOW DOSE LITHIUM—150MG/DAY—TO PREVENT BOTH ALZHEIMER’S AND DEPRESSION.

Dementia is a major public health problem.  The prevalence is 1%  at the age 60 years, and rises to over  30% of the population by age 90 (Nunes et al., 2007).   A history of depression doubles the risk of Alzheimer’s.  Bipolar disorder increases risk of Alzheimer’s perhaps 6 fold.   Perhaps people with mood disorders should start on prophylactic lithium 150mg/day by age 60 y.o. Even lithium 150mg per week might be prophylactic against Alzheimer’s.  High amounts of lithium in the drinking water  results in less than 1mg/day being ingested.

  • LITHIUM ROCKLithium prevents brain cells from dying. It greatly increases Brain Derived Neurotrophic Factor (BDNF), which is the growth hormone of the brain, and it also prevents cell death.
  • Lithium in the drinking water reduces risk of Alzheimer’s. In areas of the United States where there is more lithium in drinking water
    [but still in trace amounts], there is significantly less suicide and Alzheimer’s compared to area that have less lithium in the water.   See NYT article on lithium in water from 9/2014.
  • 1/3 of people with Bipolar I Disorder (manic depression) develop Alzheimer’s.  If they are on lithium, only 1/20 get Alzheimer’s—i.e., lithium seems to bring their risk to population average.
  • Depression doubles the risk of dementia (da Silva et al., 2013; Kessing et al., 2008).
  • It is possible that even low doses of lithium will gradually improve your mood disorder over time. If your chronic depression is vastly better 4 years from now, it could actually be secondary to low dose lithium you were taking.
  • When on even a low dose lithium, if there is a serious brain injury, 50% more of the brain survives.  There are elegant studies on animals demonstrating this.
  • Lithium expands the grey matter of the brain grow slowly over time.  It is the only substance that does this.  The neuroscientists say this is a good thing.
  • On a basic science level, lithium has a lot of positive effects on the brain [review of neurotrophic effects of lithium by Machado-Viera, Bipolar Disorder, 2009: 11: 92-109.]
  • Lithium helps depression. It  works better at  low doses of 300mg to 600mg than at 1200 or 1500mg/day.
  • Lithium specifically reduces suicide. There are a number of studies on this.
  • Recently psychiatrists have been noticing that sometimes 150mg of lithium helps depression. In the last few years, especially the last 2 years,  I have collected 32 patients [26 women] whose mood dramatically lifted to normal in ≤ 2 weeks when only 150mg lithium was added.   They immediately lose the benefit if they stop it.  There must be many other  people who lithium help their depression gradually over the long term.  When the patient is doing extremely well a year or two later,  however, it is difficult to prove that lithium was involved.   I was not surprised over the years when  many patients had an immediate antidepressant effect when lithium 300mg to 900mg was added to their standard antidepressants, but was surprised to find out how often 150mg helps.  I have a 41 y.o. woman with Bipolar I Disorder (manic depression) who, after 10 years, is fairly stable on a cocktail of mood stabilizers.  However, she says she has only been perfectly euthymic—for the first time in 25 years– since being on lithium 150mg twice a week.  Her mood is also excellent on 150mg 3 times a day, but then she has a tremor.  On 150mg once a week she is
  • AN EXAMPLE of depression prophylaxis with lithium 150mg: I have a 69 y.o. woman with chronic depression I have been treating for 18 years.      Recently she said,  “I think that the best medication you ever gave me is that little lithium pill.”   She pointed out that she has had no severe depressions in 7 years since being on lithium 150mg.   She had double depression—lifelong mild depression with  interspersed severe major depressions once or twice a year. .   She had a profound depression  7 years ago, and could barely walk or talk.  She became euthymic within a few days of starting on lithium 300mg, thyroid hormone and Abilify/ aripiprazole.  Later we reduced lithium to 150mg.   Since starting lithium 7 years ago, her chronic mild depression has also been in remission 95% of the time.  The only other antidepressants now are Lamictal/ lamotrigine 200mg and the thyroid hormone Cytomel (liothyronine) 25mcg— much less than what she needed prior to lithium.
  • Some people say that maybe we should classify as an essential trace element (like selenium, manganese, copper, iodine, zinc, chromium, vanadium, selenium, and molybdenum). Certain enzymes do not function well without a trace element. Should a small amount of lithium be added to a multivitamin?  If you only take 150mg/ day, look upon it is a nutritional supplement.

uses-of-lithiumOTHER BENEFITS:

  • Lithium seems to help with herpes and with seborrheic keratosis.
  • It treats cluster headaches.
  • Lithium causes no sexual dysfunction.
  • Sept 17, 2003 JAMA: another study indicating lithium specifically reduces suicide. 20,638 patients with at least one diagnosis of bipolar disorder were analyzed. Patients on Depakote (divalproate) were 2.7 times more likely to commit suicide than patients on lithium.

 

  • negatives: it can exacerbate psoriasis and acne; in larger doses [e.g., >600mg/day], it can cause kidney damage
  • NOTE: After 6-10 affective episodes [manias, mixed state episode, or MDD), the efficacy of lithium for manic depression approaches that of placebo.