Lithium

1. What Is Lithium?

Lithium is an alkali metal (a group of metals) and the lightest metal of all. In nature it occurs in rock, in mineral springs and in very small amounts in drinking water. In medicine it is given as a salt to stabilize mood. In addition, it is being investigated whether very small amounts in drinking water play a role for health.

2. Where Is It Found, and What Is It Made From?

Lithium is present in small amounts in rock, soils, mineral waters and in drinking water. In medicine, salts such as lithium carbonate or lithium citrate are used.

3. What Does Lithium Do? What Research Shows

Dementia and Alzheimer's Disease

In mild cognitive impairment (mild mental decline), low-dose lithium slowed decline more than placebo in one study and favorably changed Alzheimer-typical protein levels in the spinal fluid 4341. Another small study in mild mental decline reached none of its primary goals 38. In Alzheimer's dementia, a pooled analysis found no confirmed improvement 16. Favorable effects on Alzheimer-typical protein deposits appear mainly in animal studies 2126. Observational studies found an association with less frequent dementia, but this does not prove a cause 19272832.

Bipolar Disorder

In bipolar disorder (an illness with severe mood swings), lithium in pooled studies lowered the risk of new mood episodes compared with placebo (a sham treatment) 57. In children and adolescents with acute mania, in a pooled analysis more treated people responded under lithium than under placebo, but the symptoms did not decrease more strongly 9. In a comparative study in adolescents, quetiapine, another agent, worked more strongly than lithium 36. Reviews also speak in favor of an effect in children, around birth and in old age 613.

Depression

In depression the picture is inconsistent. As an add-on to antidepressants, in a pooled analysis more people responded under lithium than under placebo; however, after a correction for bias this was no longer certain 4. After magnetic stimulation, lithium prevented relapses just as much as a continuation of the stimulation, there was no difference; however, more side effects occurred under lithium 39. In other comparisons, lithium as an add-on worked similarly to or more weakly than other agents 343537. The studies are mostly small and short.

Neuroprotection

Reviews report protective effects on nerve cells with long-term lithium treatment 2228. One study found in young people with a first manic episode a more favorable change in a nerve pathway under lithium compared with quetiapine 45. Other studies found no difference 4044. The findings come predominantly from reviews and small studies, and the salt forms are mostly not named in more detail.

Suicide Prevention

Observational studies found fewer suicides under lithium in affective disorders 29. Higher lithium levels in drinking water were associated with lower suicide mortality 131. In studies with random assignment to lithium or placebo, a protective effect is not certain 3310. The drinking water findings come from comparisons of entire populations and show associations, not causes. It remains open which salt form and which blood level are decisive.

Trace Lithium in Drinking Water

A pooled analysis and an overview found a lower suicide mortality rate with higher lithium levels in drinking water 131. Two further review articles examine the topic. One tests the assumption that higher lithium levels in drinking water are associated with a lower suicide rate 46. The second considers such an association possible 47. These are observations of entire populations, not controlled individual studies; they show associations, not causes. The strength of evidence is low.

Other Investigations

In children and adolescents with conduct disorder, a review found an effect against aggressive behavior 13. Lithium carbonate in addition to radioactive iodine increased the cure rate in an overactive thyroid 11. In Huntington's disease and a form of ataxia (a movement disorder), a review reports improvements, but not in amyotrophic lateral sclerosis 30.

4. How Was Lithium Taken in the Studies?

In the studies, mostly lithium salts were given, without naming the exact salt form. Individual studies used lithium carbonate, sometimes as a preparation with delayed release or at low dose. Lithium citrate, lithium orotate and dissolved lithium chloride were not tested as separate forms. Often lithium was given in addition to other active substances, for example to antidepressants or antipsychotics.

5. Is Lithium Safe? Side Effects in the Studies

Lithium salts were associated with impaired kidney function; ongoing monitoring of kidney values is considered indispensable 23. Severe lithium-related events were not reported in children and adolescents, but the studies are mostly small and short 613. In older people, kidney function remained unchanged under low-dose lithium in one study, but more side effects occurred than under placebo, such as weight gain 42.

All details with tables and sources: full expert page on Lithium