Lithium supplement and medication, orotate benefits and side effects
Feb 20 2014, by
Ray Sahelian, M.D. 

Lithium is a naturally occurring substance. As a prescription medication, it reduces chemicals in the body that cause excitation or mania and an old and inexpensive drug, it may help lower suicide risk in people with mood disorders such as depression or bipolar disorder. Lithium carbonate is a salt that was first approved in the United States in 1970 to treat manic depression bipolar disorder. Today, it remains a commonly used medication for this illness. it is prescribed for the prevention of suicide and deliberate self-harm in patients with mood disorders. There are several supplements useful for depression including 5-HTP, SAM-e, and St. John's wort. SAM-e and St Johns wort may induce mania in high dosages.

Available without a prescription
Lithium orotate has been marketed as an alternative to lithium carbonate. As this natural supplement, lithium is joined with an orotate ion, rather than to a carbonate ion. There are a number of companies that sell these pills and I am currently still trying to evaluate whether its benefits outweigh its risks. For the time being I find 5-HTP, SAM-e, and St. John's wort to have been studied much more and at this time appear to be safer for the treatment of depression.

Alcoholism
Lithium orotate in the treatment of alcoholism and related conditions.
Alcohol. 1986.
The subjects were 42 alcoholic patients (33 males and 9 females) who were treated with lithium orotate during an alcohol rehabilitation program in a private clinical setting for at least six months. The 42 patients studied displayed a multitude of complaints in addition to chronic alcoholism. These included liver dysfunction, seizure disorders, headaches, hyperthyroidism, affective disorders. Meniere's syndrome, liver and lung cancers. Thirty-six of the 42 patients studied had been hospitalized at least once for the management of their alcoholism. Lithium orotate was given, 150 mg daily, with a diet low in simple carbohydrates and containing moderate amounts of protein and fat. In addition, calcium orotate (for hepatic involvement), magnesium orotate, bromelaine, and essential phospholipids (for cardiac problems), and supportive measures were instituted, if required. This medication proved useful as the main pharmacologic agent for the treatment of alcoholism. Adverse side effects noted were minor, i.e., eight patients developed muscle weakness, loss of appetite or mild apathy. For these patients, the symptoms subsided when the daily dose was given 4 to 5 times weekly.

Comparing Lithium Carbonate, Chloride, and Orotate
Lithium orotate, carbonate and chloride: pharmacokinetics, polyuria in rats.
Br J Pharmacol. 1976.
The pharmacokinetics of the lithium ion administered as lithium orotate were studied in rats. Parallel studies were carried out with lithium carbonate and lithium chloride. No differences in the uptake, distribution and excretion of the lithium ion were observed between lithium orotate, lithium carbonate and lithium chloride after single intraperitoneal, subcutaneous or intragastric injections or after administration of the lithium salts for 20 days in the food. The findings oppose the notion that the pharmacokinetics of the lithium ion given as lithium orotate differ from lithium chloride or lithium carbonate. Polyuria and polydipsia developed more slowly in rats given lithium orotate than in those given lithium carbonate or lithium chloride, perhaps due to an effect of the orotate anion.

Bipolar Disorder
Lithium is used to treat manic episodes of manic-depressive illness. It helps to prevent and control symptoms of mania such as hyperactivity, rushed speech, poor judgment, reduced need for sleep, aggression, and anger.

Q. If one is deficient in lithium could this be the source of bipolar? And if so would it not make more sense for a doctor to check lithium levels before diagnosing one with bipolar? Also I read that lithium is a salt and other times I read it is a mineral?
   A. Salts are compounds resulting from a chemical reaction between an acid and a base, in which the acid's hydrogen atoms are replaced by metal atoms of the base. Most salts are crystalline ionic compounds, such as the common table salt (sodium, a mineral, plus chloride). Just because a medication helps treat a condition does not mean that the condition is due to a deficiency of the medication. There are many causes of bipolar disease that have nothing to do with a mineral deficiency.

Q. I would like to know if Lithium orotate works for bipolar depression. I am extremely sensitive to medications and have depression and anxiety. Do not like taking medications. The side affects out way the reason for taking the drugs in the first place.
   A. I have not seen enough studies with it to know whether it is a better alternative than other natural options available for this condition and how safe it is in the long run. If it is to be used at all it should be done in lowest dosages possible with medical supervision.

Wide range of uses
Lithium is sometimes prescribed by doctors for purposes other than those commonly used such as in the treatment of acute brain injuries (e.g., ischemia) and chronic neurodegenerative diseases (Alzheimer's disease, Parkinson's disease, tauopathies, and Huntington's disease). Evidence suggests that depressive illness is not a mere neurochemical disease, but is linked to gray matter atrophy due to the reduced number/size of neurons and glia in brain. Importantly, neurogenesis, that is, birth/maturation of functional new neurons, continues to occur throughout the lifetime in human adult brains (e.g., hippocampus); the neurogenesis is impaired by multiple not-fully defined factors (e.g., aging, chronic stress-induced increase of glucocorticoids, and excitotoxicity), accounting for brain atrophy in patients with depressive illness and neurodegenerative diseases. Chronic treatment of lithium, in agreement with the delayed-onset of mood-stabilizing effects, up-regulates cell survival molecules (e.g., Bcl-2, cyclic AMP-responsive element binding protein, brain-derived neurotrophic factor, Grp78, Hsp70, and beta-catenin), while down-regulating pro-apoptotic activities (e.g., excitotoxicity, p53, Bax, caspase, cytochrome c release, beta-amyloid peptide production, and tau hyperphosphorylation), thus preventing or even reversing neuronal cell death and neurogenesis retardation.

Lithium side effects, caution, danger, risk, toxicity and overdose
Lithium side effects include nausea, vomiting, diarrhea, slurred speech, drowsiness, or weakness. Use can lead to weight gain and cause high rates of abnormalities in the thyroid and parathyroid glands.

Find Serenity Now side effect overdose
Lithium toxicity from an Internet dietary supplement.
J Med Toxicol. 2007.
An 18-year-old woman presented to our emergency department after ingesting Find Serenity Now 18 tablets; each tablet contained 120 mg of lithium orotate [3.83 mg of elemental lithium per 100 mg of (organic) lithium orotate compared to 18.8 mg of elemental lithium per 100 mg of (inorganic)]. The patient complained of nausea and reported one episode of emesis. Her examination revealed normal vital signs. The only finding was a mild tremor without rigidity. A urine drug screen was negative, and an electrocardiogram showed a normal sinus rhythm. The patient received intravenous fluids and an anti-emetic. After 3 hours of observation, nausea and tremor were resolved, and she was subsequently transferred to a psychiatric hospital for further care. Chronic lithium toxicity from ingestion is also of theoretical concern.

Ann Clin Psychiatry. 2013. Possible dangers of a "nutritional supplement" lithium orotate.

I have bi-polar disorder and PTSD. I'm on several medications including Lithim Carbonate 300 mgs at night. Ever since I have been on it, my weight has gone up. I have gained almost 20 pounds since I have been on the drug. I don't want to take it anymore and am looking into the Lithium Orotate. So, do you know if it has weight gain side effects as well?
   I have no reason to suspect the adverse effects would be significantly different between different forms of the mineral.

I have been taking lithium aspartate 5mg for the past 3 mos. I am now suffering from erectile dysfunction, ED. Could this be the cause?
   Impotence or sexual dysfunction is a known adverse reaction.

I take 100mcg levothyroxin daily and want to know if I can safely take lithium orotate. I read that it aggravates hypothroidism. I want to take a low dose.. maybe split the 120mg into 4 and take 1/4 two x a day. Is that safe to do? If not, what is a good alternative?
    Each person is different in their reaction to combinations of hormones, medications and supplements. There are no simple answers and much depends on the dosage used. A safe way to begin is to use a very low dose of the supplement and have a physician monitor the changes in thyroid function over time.

How is it available?
There are several different prescription brands of lithium dispensed as tablets, capsules, or liquid. Some examples include Lithobid and Eskalith CR.

Lactation and breastfeeding
Nursing mothers who are on lithium therapy may safely breastfeed their infants if the daily dose of lithium is less than 800 mg a day, and if the infant is completely healthy. Perhaps the first month or two of life the infant may also be bottle fed a little so that the amount of breast milk with lithium exposure is less. Lithium does cross over into breast milk but in small amounts.

Ideal lithium blood level for the treatment of bipolar disorder
In the long-term treatment of bipolar disorder doctors should try for serum lithium levels of 0.5 to 0.7 mmol/L, while higher levels may benefit patients with predominantly manic symptoms.

Interactions with medications
What is your opinion or information about taking this supplement along with other bipolar meds such as lamictal or anti psychotic drugs? I take a low dosage of 600 mg with lamictal, seroquel and Ritalin. For rapid cycling and am looking for alternatives so I can get pregnant.
   It is difficult to predict interactions between various medications, much depends on the dosage, time of day used, and also on the threshold or sensitivity of the individual using it, and how long they have been taken together. There are no easy answers.

Questions
Jonathan Wright, MD raves about lithium aspartate, dosage 5 mg., and/or lithium orotate in his newsletter as an inexpensive aid to prevent Alzheimer's as well as alleviate depression and mood swings. Solaray makes lithium orotate sold at health food stores, There's also a supplement sold online called Serenity that contains it. As a follower and loyal fan of Dr. Sahelian's products, and as one who respects and listens to the doctor's feedback, would really like to know his opinion.
   I did a search on Medline in 2011 and could not find any human studies with lithium aspartate and dementia or Alzheimer's. I found one lithium aspartate clinical study.

Lithium aspartate in the treatment of chronic alcoholic patients with brain damage--a controlled study
Nervenarzt. 1991.
The efficacy of lithium aspartate in reducing alcohol consumption was examined in a double-blind, placebo controlled cross-over study. Subjects were male alcohol-dependent in-patients with organic brain disorder of moderate or severe degree. There was no evidence of improvement.

Q. My husband has a condition where he cannot take antihistamines, anticholinergics, over the counter cough remedies, or nicotine. In 1986 his doctor gave him a prescription antihistamine for a bad cold and my husband ended up in the ER after he developed delusions. After that, whenever he got stressed at work, he would start smoking and drinking huge amounts of coffee and would get very wired and irritable. Then he would realize (with my help) what was happening and get himself back in balance by stopping the caffeine and nicotine. I am a former nurse and I watch his intake of supplements and medications carefully. But in 2001 we both got a very bad flu. I was sleeping for about 20 hours a day for several days. My husband was taking care of me, though he was very sick himself, and unknown to me he started drinking huge amounts of Theraflu as he thought it would help him feel better. Then he took Tylenol with codeine. He went off the planet again, unfortunately at work, and when his boss called me, I had to have my husband taken to the hospital. He was admitted to the mental health ward and kept there for 9 days. They told me he was bipolar and put him on high doses of Depakote which nearly killed him. The doctor said it would help him sleep, but instead he couldn't sleep at all and they wouldn't believe him. I called the doctor and pretended I was in total agreement with him and got him to release my husband to me. That night my husband insisted on taking a regular dose of Depakote --against my better judgment--and he went up like a kite. Started screaming at me that he felt terrible. He was itching all over and his skin was very red. His pulse rate stayed at 160 to 180 for several hours. Needless to say, I threw away the Depakote and found a real doctor. I was very, very fortunate in that I found a psychiatrist who agreed with me. He said if my husband had taken much more Depakote it would likely have killed him. One of his brothers is diagnosed bipolar and has been on lithium for about 20 years. I told our new doctor that I would like to try supplements and dietary changes to help my husband and that we would avoid the drug form of lithium if at all possible, since we'd seen what it did to his brother. The doctor agreed to monitor the situation while we gave that strategy a try. My husband now takes a green source multivitamin, choline, fish and flaxseed oil, and B vitamins, including sublingual B-12. My husband now takes lithium orotate as needed throughout the day. He usually has 2 or 3 a day, more if he feels unusually stressed, for example if there's a lot of overtime at work. I also take one tab at bedtime as it helps me sleep. The lithium orotate dosage in the 135 mg tab is 5.8 mg and we use the LifeLink brand. My husband is very pleased that he is able to stay well with just the supplements and the LifeLInk lithium orotate. He is more content than he has ever been, does not suffer from anxiety and depression the way he used to, and has been able to avoid smoking. There don't seem to be any lithium orotate side effects for my husband. He had one physical exam since starting it and all blood and urine tests were normal. PSA well within normal limits. Total cholesterol about 150. A month ago he had a gallstone attack after eating some very spicy food. Other than slightly elevated liver enzymes which the doctor said were caused by the gallstone problem, tests were normal. MRI showed enlarged bile duct, but didn't find any stones. The doctor believes the stone passed. Also, recently my husband has had problems with hypoglycemia. But he has not been following his healthful diet. He eats a high carb breakfast (cereal) and was eating peanut butter and jelly sandwiches for lunch, bananas for his afternoon snack, and a soft drink on the way home.
   A. This is very interesting, thank you for sharing this with us. We are somewhat concerned about the lack of research and safety of lithium orotate and wish some organizations would do testing to see if it leads to any renal harm or kidney toxicity.

Q. I'm wondering if you happen to have a list of quality suppliers?
   A. I have not seen any testing of lithium orotate supplement products so I do not know which suppliers are reliable.

Q. I'm wondering if lithium oratate would be as beneficial for borderline personality disorder, which my 23 yr old has been diagnosed as having. She is currently scheduled for an appointment with a holistic medicine doctor & I believe the doctor is going to try lithium oratate. I've read much about bi-polar, manic depression. etc....nothing on borderline personality disorder.
   A. A search on Medline in September 2008 did not reveal studies regarding the use of lithium orotate for borderline personality disorder BPD. Perhaps her doctor has come across such studies.

Q. I have read so much about lithium orotate and you have shown excellent documentation as well. So I am writing to let you know I have plans to take lithium orotate as soon as I can, but what the situation is is that I am currently taking Lithium Carbonate 900mg and I dont want to take them both at the same time yet I dont know what the transition should be like. I really dont want to find out the hard way so I wondered if I should make a transition slowly taking them both and end up taking the lithium orotate or just switch on point? I am going to take lithium orotate regardless but I really pray you might have any advice for what you would do.
   A. The process of switching from lithium carbonate to lithium orotate has not been well studies by researchers. It is difficult to give a reliable answer since there are many lithium orotate supplements on the market and we have not seen evaluations regarding their purity and accuracy of the supplement fact panel. One option is to make the change gradually by decreasing the dosage of the lithium carbonate while starting the lithium orotate, but, to be safe, this should be performed with medical supervision and blood tests done to see whether the lithium orotate is maintaining lithium blood levels to the desired levels. There is a great deal of individual variation and no firm answers can be given.

Q. I wonder whether you might start offering a low-dose lithium product? As you know, there is a lot of research showing lithium supplement has neuroprotective, neurogenerative, and immune-boosting qualities. Lithium supplement seems to be available from other sources in 5 mg. capsules. It would be nice if it came in a variety of doses like 10, 25 and 50 mg. capsules.
   A. I am looking into this matter but I have a concern regarding long term safety.

Q. I have been given a bottle of lithium 5mg-as lithium orotate and i need to stop this Tranxene as it is not calming me anymore but seems to be working the other way. Can i take the lithium as i wing off Tranxene as i have been on it a year?
   A. This is a decision you and your doctor need to make. Some people may be able to easily make a change from Tranxene to another medication or natural supplement, while others may not.

Q. Have you found any reliable retail suppliers as of yet? Also, would there be any harmful effects in combining your Mind Power Rx with lithium orotate?
   A. We still have not found a reliable source as of 2013. I suggest not using lithium orotate supplements and Mind Power Rx the same day, but rather alternating their use.

Thyroid functions in lithium-treated psychiatric patients: a cross-sectional study.
Biol Trace Elem Res. 1999. Department of Nuclear Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
In the present cross-sectional study, thyroid functions (viz. thyroid radioiodine uptake [RAIU] and serum T3, T4, and thyroid-stimulating hormone [TSH]) were evaluated in 24 healthy controls and 132 outdoor affective disorder patients. Eleven of these patients were to receive lithium (Li) and the remaining 121 patients were at different stages of Li treatment ranging from 0.7 to 240 mo. RAIU was found to increase significantly throughout the Li therapy and was associated with the corresponding rise in TSH levels. In totality, Li treatment induced subclinical hypothyroidism in 51/132 (39%) of patients. However, 8/51 patients who belonged to known iodine-deficient belt had abnormally high TSH (range 15.2-76.0 microIU/mL), low T4 (5.3+/-2.5 microg/dL), and normal T3 and at least 4 of these 8 patients were clinically hypothyroid. T4 levels declined significantly with Li treatment ranging from 61 to 240 mo as compared to the corresponding values in the pre-Li group. The T3/T4 ratio was found to be significantly higher with Li treatment ranging from 0.7 to 6 mo in comparison with the pre-Li group and this value returned to base levels after long-term Li therapy. High T3 and T4 were observed in 13% and 12% of the patients, respectively, as compared to the corresponding control values.

I read somewhere once that if one takes lithium orotate it will not show up as drug usage on a drug test. Could you please tell me if this is true?
    Most drug tests check for illegal drugs or certain prescription medications such as opiates or benzodiazepines. It is unlikely that a routine drug test done by a company on their employees would check for lithium.

I've read your comments about lithium orotate. My fam. doctor diagnosed me with fibromyalgia. I'm not sure that's truly the case. I was put on Cymbalta, but after 1,5 years I went of the medicine. They don't tell you the side effects when you stop an antidepressent. I had severe brain saps. My friend an chiropractor, but now specializes in homeopathic medicine, told me to take lithium orotate. I started with 3 pills for a couple weeks and have gone down to one a day now. The brain zaps stopped imediately. I threw all the rest of the Cymbalta out the door. I feel very good and feel to have my feet back on the ground. (with the  ymbalta I felt I was not really there). I think it's a great medicine with no side effects (to me) inexpensive and much to totally safe. I use Dr. Hans Nieper 120 mg. tablets. (I'm not trying to advertise for him in any way), Dr. Hans Nieper is of Hanover, Germany, but his pills are produced in the USA. I hope this information is helpfull to you and for your patients.
    Thanks for writing, it is informative. Dr. Hans Nieper died in 1998.

I've been dealing with a bit of anxiety and depression for the past couple of years and I'm kind of worried about developing memory and other thinking problems some time down the line because of them. I found an article talking about chronic low-dose lithium supplementation and how it can prevent or maybe even partially reverse cognitive problems, something to do with excitotoxicity, brain atrophy or something. I was wondering if you came across any studies concluding that chronic low-dose lithium was beneficial. I found some studies saying it was and some saying it wasn't. I'm looking at low- dose because I'm a bit worried about developing kidney and thyroid problems in the long run.
    I don't have a good understanding of the benefits and risks of long term lithium orotate supplement use, so I would tend to avoid the regular use of this supplement at this time until more studies are published.

Is lithium orotate or aspartate OK if you a person has liver disease such as cirrhosis?
    This mineral is known to cause kidney disease and does not seem to have as clear an effect on a healthy liver, but it is not clear to me how it would influence a diseased liver such as cirrhosis.

Do you think it is absolutely necessary to supplement with iodine if one takes 10-20 mg lithium aspartate per day?
    A search on Medline in June 2010 did not reveal any studies that have looked into this matter.

Is the aspartate from lithium aspartate an excitotoxin?
   I don't know at this time.

I am an individual in Canada who has been taking Lithium Carbonate since the 1970's, and it is damaging my kidneys. I have read a fair bit about Lithium Orotate but don't know if it's available in Canada for purchase. My pharmacy does not have a source for it and the Health Food Stores that I've contacted don't carry any lithium at all. If a prescription is required I'm certain that my Doctor would write one for me, but I need to know where I can get it. I have gradually reduced my dosage over the years and now take only 300 mg of the lithium carbonate, it's my understanding that a smaller does of the lithium orotate would required and that it would not be harmful to my kidneys.
   I have not seen long term human data as to the effect on kidneys of the carbonate versus orotate versions so I don't know how they compare in this regard.

I recently read a newsletter by a Dr. Howenstein that touted the anti-aging benefits of taking small doses of lithium aspartate. For a few weeks I had been taking one 6mg of lithium aspartate and maybe two to three times during the same time period taking one 500mg capsule of L-arganine per day. I woke up at midnight and was sweating and noticed I had bitten my tongue rather serverly. I went to the ER room and the doctor there said that the symptoms I described were evidence of a seizure. There is no history of seizures on either side of my family tree. I have been putting my own herbs together for the past 15 years and attribute that to the fact that I have not even had a sniffle durring the winter or any sickness!! The ER doctor turned this in to the Health services and now I face loosing my drivers license. This is insane...! I do not want to be put on any kind of drug because someone else says so based on a guess.