Should We All Take a Bit of Lithium?
nytimes.com
nytimes.com
1) therapeutic doses of lithium as a prescription medicine for mood disorders are MUCH higher than doses occurring through lithium in the water supply, and yet
2) there is perhaps some epidemiological signal suggesting differing rates of suicide and depression in places where lithium levels in the water supply are higher.
Kay Redfield Jamison, author of some of the most compassionate books about depression you will ever read,[1] credits lithium with saving her life. I'm glad her life was spared so that she could write from the inside about what it is like to have a severe mood disorder, and apply her creativity to communicating with people who cannot directly understanding her personal experiences or the experiences of other patients.
I think the article's call for further research, at a minimum, is worth taking seriously. The neuroprotective effect of lithium demonstrated in animal studies (verified by necropsy and examination of the animal's brains after the animals die) is well established, so we may as well check whether adjustment of water supplies by intentional supplementation has a beneficial effect if (and only if) epidemiological studies and animal experiments suggest doing so. This is, after all, how the beneficial effects of fluoride on tooth enamel strength and resistance to decay were discovered.
Yes, others will point to the higher dose for psychiatric patients.
I would point to the soulless robot, the empty husk of a once vibrant, creative brain.
We are devs, and our brain is our livelihood. In me it killed my creativity and my passion. Not only did I not want to code anything new, I could not conceive of new things. I stopped improv jams on guitar, I could not write songs. I became wonderfully adept at doing scales. Scales over and over.
I'll take my mood disorder- because it comes WITH emotions.
This is just to give you a 'crazy person's' impression of Lithium. Your results may vary.
I agree that when I first got on those meds at 21 after a psychotic break I was totally torn up. Now at 35 I couldn't imagine my life any other way. Have I become less creative? I honestly don't know and it's kind of frightening to think that perhaps I have. How would I ever know?
If you haven't seen what your life you be like permanently institutionalized (I've been hospitalized for mania 6 times) perhaps strong drugs aren't for you. If you have seen the other option (life inside a hospital), it makes a lot of sense.
If you think Li makes you a zombie, try intramuscular haldol or seroquel or even ativan. Those will knock you out, the first one literally. :)
Lithium is a very harsh mistress, but if you have type 1, which is akin to emotional epilepsy, she will bring you to heel.
I guess I took dangerous risks, depending on who you talk to. :) I was never suicidal or homicidal, but I definitely did things that were out of character and scary to people outside. One of the most interesting things is that I remember everything and it all seemed 'rational' at the time. Not rational per the normal definition of rational, but following my line of reasoning everything made sense. I don't want to go into too much details online as it wouldn't take Sherlock Holmes to figure out who I am. As it is you can google stalk me and eventually figure out my story. Regardless it isn't that interesting.
The threat part is that 1/5 people with bipolar die of suicide w/ 25% to 50% attempting. That is so, so scary. I was deeply affected by the passing of Robin Williams for that reason. That's almost always on the depression side.
For me, my mania was just ... extra happy ... going right up into the mystical amazement with life, the universe and everything that people typically associate with psychedelics, etc. 14 days into a hospital stay (my longest was 17 I think) that happy go lucky feeling sleeping ~1-3 hours max on heavy sedation becomes... much more agitated and frustrated.
Not attempting to edit this post for clarity, but yeah, that's a rough sketch of my situation. It's been 6 years since I was last hospitalized (I had my friends take me in), but I'd say the feeling coming on is like an electric charge of infinite energy reverberating from the base of my skull. Sounds awesome in theory, but it doesn't convert to tangible output when the smoke clears. I could write on and on about these experiences, but so can many others... /r/bipolarreddit and /r/bipolar are some spaces where people let loose on their experiences.
I described my experience with lithium, and while there were sedatives and antipsychotics that I was prescribed which had a far greater numbing effects, I was not speaking to them.
All of the medications I tried had different consequences, Lithium's were not the worst (Lamictals were the most interesting musically).
Be well. I can only hope our life experiences both rock regardless of whatever bumps in the road we hit. I didn't put the low-lights of my life on meds into my post, but they are legion. Leeeeeeegion.
The article omits 7up (which contained lithium for a while) and lithia water which you can buy online right now: http://lithiamineralwater.com/store.htm
It would be one thing if micro-doses of lithium were sold as a supplement, which individuals can opt to take. But the article goes as far as to suggest adding it to drinking water -- it seems very irresponsible in my eyes to leave it to the government to decide "how docile" the population should be above the natural level / what trade-off with suicide rate is acceptable.
There are better ways to deal with the problem of suicide than pushing society slightly closer to the "souless robot" end of the spectrum.
For example, the amount of moisture in your skin: too little and it cracks and bleeds, too much and you get fungal infections. But adding moisture to cracked-and-bleeding skin isn't making it "a bit more fungal" -- it's pushing it into the healthy buffer range.
I'd imagine there are many, more complex, factors involved in brain chemistry / mood suppression, so it would be a lot more difficult to determine where this middle lies.
If you're using high suicide rates to suggest we're not in the middle and need more lithium in everyone's water, I'd have to disagree. In the vast majority of cases, a better healthcare system which ensures those who need it are connected with mental health professionals would help nip the problem in the bud. Rather than solving it with these lithium microdoses, causing to those on the verge of suicide to not have the lucidity of emotion to commit to the act, and the rest of the population having their brain chemistry played with too.
Here's a useful comparison:
Before we were iodizing salt, most people were actually in "the middle" of iodine-consumption. Anywhere from "nearly none" to "tons and tons" was "the middle"--your body can work miracles to create homeostasis from random inputs. But some people were getting no iodine at all, and these people would get very sick.
So we added just a little bit of iodine to salt. The iodine-deficient people--the people who were previously getting utterly no iodine--stopped getting sick, because now they were getting a little bit of iodine, and that was enough. Everyone else was getting slightly more iodine--but this didn't push anyone from "getting a tolerable amount of iodine with the excess just excreted" to "having a hyperiodine problem." There was nobody exactly one dose away from having too much iodine, because we just don't consume that much iodine.
This same story holds for any vitamin or mineral. Calcium, phosphorous, iron, etc. are all things most people get the right amount of--but "the right amount" is almost any amount, because the body knows how to take just the right amount from the stream of input it's getting, and throw the rest out. The only wrong amounts are either zero, or more than exists in any human-friendly environment.
Actually, there was: 'thyroid shock'. Iodization in the USA was accompanied by a wave of, I think, a few thousand deaths on net when people who grew up iodine-deficient were suddenly exposed to iodized salt. (This was covered by one of the historical papers I cite in http://www.gwern.net/Iodine although I forget which.)
Of course, the benefits of iodization were on net huge and I'm very much a fan of iodization, but it would be wrong to say nobody was hurt by the introduction of iodized salt.
I guess another way to think about environmental chemicals is by analogy to poisons: if they were common in the environment, you'd have a tolerance to them, but since they aren't, you don't. You can build up a tolerance by parts, at which point the poison stops being one and just becomes another chemical the body handles.
What is there to show that "this same story holds for any vitamin or mineral"?! Surely there are many which have no positive effect on the body, where zero would be the best dosage. What law of biology suggests that every mineral is in some way beneficial to the human body?
Lithium happens to have an effect on moods in the brain in such a way that suicide is less likely - but the mood dampening effects may well diminish people's positive emotions too (for example). For someone with no mental health issues or risk of suicide, this could well be an overall negative effect, and therefore makes no sense to force on the entire population.
I can see why the drinking water suggestion invites paranoia. As the article mentions a solution like adding it to salt could also work.
As to why that is relevant to microdosing...
- High doses: major mood suppression -> practically no chance of suicide
- Micro doses: (?) -> lower chance of suicide
Simple reasoning would suggest that (?) == some degree of mood suppression. I'm not sure how you've concluded that this "could not occur" with lower doses?
Putting it in salt is hardly better than putting it in the water supply, it's still systematic mass "medication" which would become difficult to avoid.
You call it "simple reasoning" to make your inference about microdosing, but actually we have no idea how lithium even affects the brain / mind, so it's not possible to arrive at the conclusion by reason. It would have to come from evidence from controlled studies, and I believe these indicate that side-effects are restricted to high doses.
Also, "practically no chance of suicide" -- you can't be serious about that; no drug can guarantee or even come close to that.
You already have salt with and without iodine, so no, wouldn't be difficult to avoid. Whether you should call it "medication" is debatable; giving someone vitamin C is not necessarily medication, it can be a food supplement. The same could be argued for lithium which occurs naturally in certain water springs.
i have, for years, and i currently take "antipsychotic medication", which is actually a yet another term that, thanks to marketing, has lost all meaning. the comments about lithium making you "docile", and "soulless robots" are spot on. and there are "antipsychotics" that act as mood stabilizers that are a lot less soul-sucking than lithium is.
respectfully, it is you who are misinformed.
that is the statement i was responding to.
> Even at therapeutic doses I think you are generalizing too much, as many people do not experience such side effects.
that's cool and all, but that's just, like, your opinion, man. if you're going to accuse me of generalizing, you could at least do so with something other than a sweeping, unqualified generalization. i find it amusing that this thread is full of people who don't actually take this medication telling people who actually have what its effects are. in fact, lithium has been documented both anecdotally and in research[2] to have measurable effects on cognition, and a dulling effect on mood.
[2]: http://scholar.google.com/scholar?q=lithium+cognitive+effect...
Granted, I was overstating my case there. But I maintain, not everyone has those side effects. The more pertinent point was that the article is advocating trace amounts.
One probably should avoid hastily generalizing one's own experience to what the drug's effects are like generally.
But doesn't pot bring apathy? People are actually starting to legalize that...
Again though, that's at prescription levels. Trace levels in drinking water probably won't make us all into soulless robots ripe for totalitarian rule.
edit: missing words
ATM I'm not sure of the exact concentration of the minerals, but from prior years, saying it tastes really bad isn't nearly a strong enough description. Other water supplies containing Li may be quite acceptable, but except for Ashland palatability isn't the main issue.
In the article, the cited concentration of Li at 0.170 mg/L, if referring to Li+ ion alone, the water supply would actually contain ~1/100 of the lowest therapeutic dose of Li. Medicinally Li is provided as the carbonate salt. A minimal dose is 300 mg/day, which contains ~ 30 mg elemental Li. Consuming Li-fortified water 2 L/d -> 0.34 mg Li or >1/100 of low medicinal Li dose .
Of course in nature Li is always in ionic or combined form, but the article didn't give details about Li concentrations, so it muddies the water trying to parse Li effects in any number of ways.
Here in Portland OR, city water is sourced high up near Mt. Hood from condensation of atmospheric water (mist or rain) and piped the short distance to the city. It's basically like distilled water, very low in mineral content. So low in fact, the federal government insists that alkaline minerals are added to the supply since distilled water is acidic and leaches lead from old plumbing.
However, Portland has among the lowest suicide attempt rates in the US. Our neighbor to the north, Seattle WA is among the highest, along with Salt Lake City UT and Dallas TX. http://socialcapitalreview.org/seattle-region-ranks-2nd-of-3...
Other data would show something different re: suicidal behavior but contradictory data sets are kind of the point.
Li could be a factor but I'm skeptical. We must remain alert to the hazards of drawing conclusions from population-based observational data. In this domain, experimental studies are difficult to design and conduct, but further study to narrow down confounding factors would be useful.
What I do know is water purity is sacred here. The last fluoridation campaign failed by about a 3:1 lopsided vote.
What chance would there be of adding lithium to our water supply? I think it would not be voted in.
Distilled water is neutral, it is the reference point against which acidic and alkaline solutions are compared.
Technically one could argue that it is acidic, because any concentration of [H+] is acidic, but this is like arguing that Jiminy Cricket is tall because he has height.
However, rainwater will naturally absorb CO2 in the air (and since the industrial revolution, NO2 and SO3), making it acidic.
Good call though; distilled water is neutral.
That happens when rain falls, but will also occur in the lab when distilled water is exposed to air. In that case, pH will be variably slightly less than 7.0. That's the reason calibration of pH meters relies on carefully prepared buffer solutions which are much less affected by airborne gases.
Neutrality of distilled water could be improved by boiling it to drive off atmospheric CO2, and storing it in full, sealed containers. If its pH were measured without exposure to air, it would be 7.0, or very close to it.
Lithium carbonate is about 19 % elemental lithium by mass (lithium carbonate contains two lithium atoms per molecule), so 300 mg would be ~ 57 mg lithium. Also, to my knowledge, the typical therapeutic doses are at least 900 mg/d in adults.
As a drug Li carbonate comes in 300 and 450 mg doses. Dosing is determined by monitoring the blood level of Li since only a narrow range of levels represent optimal therapeutic effect, and above that range toxicity can develop.
There is no "standard" dose of Li. It's necessary to start at lowest dose and increase gradually while monitoring the blood level. While 900-1200 mg/day is common, there are many individuals who need lower or higher dosage to have measured Li levels fall within acceptable limits.
Occasionally 300 mg/day is sufficient to get a good level, so that's the reason I used it for estimating the ratio of the natural vs. medicinal Li intake.
I can imagine posters like "The government wants to drug us".
So, just because some people are conspiracy theory nuts/paranoids/etc does not make them instantly wrong.
agreed, after the fluoride campaign, no way in hell adding Li will pass.
I used to check this more often, even before there was a WWW, when I was home-brewing beer. Then, as now, the water was so low in dissolved minerals, it was necessary to add Ca++, Mg++, etc. as yeast nutrients. All of Portland's big microbreweries probably still have do the same thing.
1000x .170mg is "1,000 times less than a fifth of a milligram," not 1000 times a fifth of a gram.
http://www.gwern.net/Nootropics#lithium has a significant number of references to the literature on lithium, and is worth reading.
Honestly, his writeups on most things are pretty spot on.
Gwern's archive is eccentric, to say the least. But it's one of the best places on the web to lose oneself for an afternoon.
Better is 'one thousandth of a fifth of a milligram'
I know our water and sewer authority publishes a report on water quality each year, but I don't remember seeing lithium content in the report.
The spring is privately owned. Here it is on google street view [1]. Lithia Springs gets their tap water from from the Dog River Reservoir in the southern part of Douglas County.
[1] https://www.google.com/maps/@33.8005688,-84.6403093,3a,75y,1...
I grew up in Cedartown, where the natural spring is also the town's water supply, so I just assumed it would be the same for Lithia Springs.
Not too surprising: I've done some poking around looking for datasets measuring lithium in drinking waters (the existing epidemiological work is, IMO, surprisingly small-n for something that seems to be routinely measured by drinking water systems), and it's pretty hard to find any lithium measurements.
People take medication and excrete some of it.
Sensible water use, especially in drought areas, means that water is reused - the water you drink has gone through someone else before you.
BBC Radio Four has a programme about this: "Urine Trouble: what's in our water?"
http://bbc.co.uk/news/health-29108330
Other uses for very-sensitive analysis of waste water include real time drug sampling. We can tell that it's the weekend by the amounts of MDMA and cocaine (metabolites?) in the water; where heroin doesn't show weekend spikes. This can be used at festivals to see if "legal highs" are actually used and in what kind of quantities.
The programme is better than this page makes it out to be.
As for lithium-infused water chilling people out; well, I've lived here long enough to know that I wouldn't walk the streets of Lithia Springs at night. There are some rowdy people living there. Maybe they all drink Dasani or Aquafina instead of the local tap water.
I can't but help wonder whether higher levels of lithium also correlate with a clean water supply, which would indicate a more affluent community. It may simply be the case that those areas with cleaner water have a better economy, and thus less crime, etc. Although lithium undoubtedly has antidepressant effects.
It's funny this article popped up on here. Today I was actually reading about how chromium picolinate was found to have a positive effect on those with atypical depression. It can be purchased from any vitamin store. It makes me wonder if trace elements (lithium, chromium, etc.) are vital to the brain's proper functioning via some as yet undiscovered mechanism.
Also, why is it that you have to have a prescription to get certain compounds, but other ones you can just purchase yourself? Is it simply the potential for toxicity?
Not likely, because the water supply of an affluent community would have highly filtered water containing few "impurities" including lithium. Further, if the community in question were conservative in their political views, the water might even lack fluoride, another component with known beneficial traits but one that has become a political issue in some places.
> Also, why is it that you have to have a prescription to get certain compounds, but other ones you can just purchase yourself? Is it simply the potential for toxicity?
No, it revolves around the issue of medical applications. If a substance has known medical applications, then its dissemination will likely be controlled by the FDA. Even advertising a substance's possible medical benefits is not permitted in the general case, without FDA approval and substantial controls. For example, if I sell willow bark as writing paper, no problem. If I sell it as a pain-killer without possessing medical authority, I will be in a heap of trouble.
I don't think it would. Typically both rich and poor communities would only be enforcing the FDA ceiling on lithium levels, which seems to be high enough that remediation is rarely (ever?) necessary, so rich/poor wouldn't correlate with levels much if all. The confounds which have come up as particularly plausible tend to deal with locations of mental hospitals, urban vs rural, and local food consumption.
Probably not. Acetaminophen is otc, yet rather toxic. I've always thought it was the potential to have unearned fun.
It doesn't matter if it's otherwise natural. Nature is inconsistent in dosages (so diverse perspectives can flourish) and doesn't have ulterior motives.
Maybe it brings down suicide rates, but what other effects does it have? Does it affect the likelihood of voting for a political party or cause? Does it affect the likelihood of political participation in general?
It's kind of like CO2 levels in the atmosphere. Higher levels will have some effect; we're basically arguing over the significance of it, what to do about it (if anything), and whether politicians can be trusted with the power to make those changes.
Similarly, mind-altering substances will affect aggregate political behavior. Once someone finds out how, they will use it to their advantage.
Should we remove trace amounts of lithium from water in areas where it's naturally occurring?
* lithium levels in drinking water change constantly, in part due to variations in rainfall in a region
Or is it not about lithium but the principle of adding stuff to water?
But the cumulative effect of many social interventions can give the government excessive power. Even beside purely political concerns, I think we have to ask whether we prefer the random hand dealt by nature, to a hand carefully chosen by the government.
Nate Silver gives a talk [1] describing how we could design cities to make people less "racist". If this was possible, it would represent an overtly political manipulation of the populace. Chemicals probably can't have such target effects, but they still raise the question of what rights the government has to manipulate people's behavior.
[1] https://www.ted.com/talks/nate_silver_on_race_and_politics
The gold standard in science is not a correlation, but a cause-effect relationship accompanied by an explanation. With respect to lithium, we're a long way from that goal.
It's a tragic condemnation of the way we do health and nutrition that if no one profits from marketing and selling something, the masses typically won't hear about the benefits of it.
http://slatestarcodex.com/2014/06/15/fish-now-by-prescriptio...
If a website can pin something on Big Pharma, well, it must be true, because a huge increase in click-through revenue doesn't lie.
EDIT: this is another example of the "fact rule" -- if you post something factual and uncontroversial, you will be downvoted with a probability of 1.
BTW: There is indeed an annoying level of unnecessary downvoting going on.
Really, it's a horrible argument. It presupposes that everyone working for Big Pharma is a sociopath who only cares about the next quarterly report.
The problem should be obvious -- lithium is an element that cannot be protected by trademark, patent or copyright. Anyone marketing it is sure to be undercut as soon as the product begins to win public acceptance and show a profit.
The other issue is toxicity. Without professional advice, people might think that, because a small amount confers benefit, therefore more is better. But, not unlike vitamin A, lithium becomes toxic above relatively low levels. For that reason it's not likely to be sold over the counter.
Also, the article talked about the benefits of consuming lithium at a tiny fraction of the therapeutic level. There are plenty of legal, common supplements that are similarly toxic if consumed in those amounts.
One can make money selling vitamin C - after someone (such as the government) has spent a lot of money running experiments and publishing the results, yielding a public good of the knowledge 'vitamin C may be good for some things'.
One will have a much more difficult time making money by investing in research establishing 'substance X is good for something', publishing that information, and then selling substance X - when substance X is cheap, widely available, and one's competitors will instantly match and undercut any of your offerings of X.
Deleted comment
My math says that .17mg*1000=170mg.
Trace amounts of lithium already occur naturally in many municipal water supplies.
http://www.merriam-webster.com/dictionary/millenniums
http://www.oxforddictionaries.com/definition/english/millenn...
Ah, of course. This is why lithium is ignored or actively disparaged, while drugs whose ineffectiveness has been demonstrated in a now-famous meta-analysis --
http://www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fj...
"Meta-analyses of antidepressant medications have reported only modest benefits over placebo treatment, and when unpublished trial data are included, the benefit falls below accepted criteria for clinical significance." [emphasis added]
-- continue to be aggressively marketed.
This is not to say that lithium is a panacea or not dangerous if mishandled. It is to say that it has measurable beneficial effects in the right doses, on the right people. No one knows why this is true, but that's true of all such medications.