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Comment by nibs | Hacker News Reader

I made that argument in a prior thread and people were really, really against it. Despite the abundance of evidence, from that study and the Japanese one [1]. I think Zinc would make a good addition too re: suicide [2]. There are two other large scale studies like this for lithium, both confirming the findings. One from Greece [3] and one from Argentina (can't find it...) [1]: http://www.ncbi.nlm.nih.gov/pubmed/19407280 [2]: http://www.jad-journal.com/article/S0165-0327(13)00626-5/abs... [3]: http://www.ncbi.nlm.nih.gov/pubmed/24072668

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It's fine if you want to medicate yourself with lithium, but it's not acceptable to forcibly medicate everyone else.

The studies you linked to show an interesting correlation between lithium in water supplies and reduced suicide levels, but you can't judge the net benefit on a single metric alone. Lithium is not without side effects, and it's unreasonable to suggest that the vast majority of the population that is otherwise healthy be subjected to those side effects for the incremental benefit of a select few. The magnitude of these side effects may be relatively small in the levels we're talking about, but the net effect is likely not negligible when applied to entire populations over the course of their lifetimes.

To add to this, I think there are many people who just plain wouldn't like do this. Even if they're unhappy or depressed they'd rather not have that feeling taken away by a mood stabilizer.

I'm not going to argue with the fact that it results in "better" outcomes in some people's minds, but personally I'd rather accept an increased suicide risk. I'm sure I could take any number of mind-altering substances every day and I'd feel great, but that doesn't mean it's something I want to do.

Lithium is an element, not just a medication. The element is used to medicate people with bipolar, in huge dosages. You and I both consume lithium every day. We may consume slightly more or less than others. The ones who consume slightly more kill themselves significantly less, with no side effects. Lithium the medication is in 100-1000x the dosages, hence the side effects. If it is bad in high (but naturally occurring, and much lower than the medication) doses, we should filter it out.

> Lithium is an element, not just a medication.

It doesn't matter if you call it an element or a medication, it has non-negligible medical effects and side effects. If it had no relevant effects, we wouldn't be discussing it here.

> The ones who consume slightly more kill themselves significantly less, with no side effects.

"No side effects" is an impossible claim to make. The studies we do have show a correlation between lithium in the water supply and suicidal frequency in the population. The side effects have not been studied.

For some hard evidence: Lithium in drinking water is correlated with changes of thyroid function: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3114818/

Lithium most certainly does have side effects that are dose- and time-dependent. The side effects may be minimal at low concentrations, but when applied to a population over the course of a lifetime, they would certainly add up. Especially for those who are most susceptible to the negative effects.

It's also not hard to imagine that lithium's suicide rate reduction effects (which are purely correlation at this point, FWIW) are due to it's tendency to mellow people out. The cognitive dulling of even small amounts of lithium orotate in healthy (non-bipolar and non-suicidal) people are palpable. Would you still advocate for lithium in the water if it reduced the average intelligence of the population by, say, 1%? I'm picking hypothetical numbers here, but the reality is that there are certainly downsides to mass-medicating people with small doses of lithium.

In that study, the water the people were drinking was up to 20x what was on the high end of the other study. If you are drinking water that is 20-100x higher in lithium, that is more like taking the lithium pills than it is like getting it from water. Further to that, the study proved nothing statistically significant... So if 20x higher lithium concentration causes no statistically significant downsides, what could the harm of being on the upper bound of what is typical in areas that are not lithium mines be?

Then we should also think about whether governments in areas where lithium is naturally higher have an obligation to remove it from their citizens' water.

Iodine is added to table salt in a lot of countries in the world. Why is preventing "physical" diseases ok, but mental diseases not?

You can still buy many kinds of salt without iodine, it's easy to opt out.

Additionally, when you talk about mental "diseases", things get a lot more iffy. We have a terrible understanding of the brain, our diagnoses for those diseases are literally check lists, without any proper tests, many people would rather have their natural mental performance than a modified version of it, which is what something like this would force you into whether you like it or not.

Per my sibling comment, are you saying water fluoridation wasn't kosher either? It's similarly "forced medication".

https://news.ycombinator.com/item?id=12167455

While you're at it, you might as well add magnesium, potassium, sulfate, phosphate, iodide, L-selenomethionine, copper, manganese, chromium, molybdenum, orthosilicic acid, and ascorbate, too.

While you can't make people exercise and eat their vegetables, they will usually drink the tap water.

But you then have to provide a way for people to opt out without any de facto penalty, which is the problem. So this would so something more suited for a dedicated drinking water system in an apartment building or complex. The mineralized water on tap goes to sinks, drinking fountains, and refrigerators, and regular old municipal water to sinks, toilets, showers, and laundry machines.

Iodine is already added, to salt.

Do take varying diets and local culture in consideration when you push for such stuff. Lithium is almost certainly harmless, but adding zinc to the water will probably cause health problems for some people.

It may be a case of doing it, and warning people not to eat too much of it. But you need actual research to discover that.

Are these available as supplements and, if so, is it safe to take them?

This may not apply to you, but I must mention it: Anyone suffering from suicidal ideation should seek professional help. These aren't the kinds of things you want to try to self-medicate away.

That said, there is a form of lithium that is available over the counter: Lithium Orotate. The amount of elemental lithium per dose is lower than you'll find in prescription lithium carbonate treatment, but you wouldn't want to attempt to self-medicate in to the prescription range anyway. Lithium has a notoriously narrow therapeutic window, and it would be too easy to dose yourself into the toxic range.

I've tried lithium orotoate myself out of curiosity for circadian rhythm modification. Although the dose is lower than that of prescription lithium, the effects and side effects were still palpable. Personally, I found no positive benefits but substantial cognitive slowing and general feelings of malaise. It's also worth noting that lithium is moderately toxic to the kidneys over time.

Having tried low-dose lithium orotate myself, I would never advocate for any amount of supplemental lithium in water supplies. Let's leave the medication to those who need it, rather than forcing it upon the entire population.

> I would never advocate for any amount of supplemental lithium in water supplies.

Would you remove the lithium from other water supplies?

Not meaningfully. I think PragmaticPulp captured it well. You can increase the amount of lithium you consume, but mostly what lithium does is improve B12 metabolism. Regardless of suicidal ideation status, taking B12 and improving diet/sleep would be better than taking lithium. B12 is consistently and significantly lower in those with clinical bipolar than controls, so it is the real problem. Superdosing lithium ensures an ideal environment for B12 metabolism, hence the benefits.

It's available as a prescription in the US. A psychiatrist can prescribe it. There are other drugs that have less side effects that can be tried first though. I wouldn't take it without doctor supervision as it's very easy to reach toxic levels in your blood. Even while on it with a doctor you need blood work regularly. It is one thing that did finally start to help me after about 10 years of dealing with bipolar 2 (which included symptoms of not wanting to live).

https://www.crazymeds.us/pmwiki/pmwiki.php/Meds/Lithium

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