What is Lithium?
Lithium is a trace mineral and alkali metal that exists in two distinct contexts:
Pharmaceutical Lithium: High-dose lithium carbonate or lithium citrate (150-1,800 mg elemental lithium daily) prescribed for bipolar disorder and other psychiatric conditions.
Nutritional Lithium: Low-dose lithium orotate or other forms (1-20 mg elemental lithium daily) available as dietary supplements, considered a trace mineral with potential neurological benefits.
This guide covers both forms, with clear distinctions between therapeutic psychiatric use and nutritional supplementation.
Primary Functions & Benefits
Essential Functions:
Neuroprotection: Increases brain-derived neurotrophic factor (BDNF) and protects neurons
Mood Regulation: Modulates neurotransmitter activity (serotonin, dopamine, norepinephrine)
Cellular Signaling: Influences inositol metabolism and glycogen synthase kinase-3 (GSK-3)
Circadian Rhythm: Helps regulate sleep-wake cycles
Neurogenesis: Promotes growth of new brain cells in the hippocampus
Health Benefits:
Pharmaceutical Lithium (Prescription):
Gold standard treatment for bipolar disorder
Reduces suicide risk in mood disorders
Treats acute mania and prevents mood episodes
May help treatment-resistant depression
Reduces aggression and impulsivity
Nutritional Lithium (Supplement):
May improve mood and reduce stress
Potential cognitive enhancement and neuroprotection
May support healthy aging and longevity
Possible benefits for mild depression or anxiety
May improve sleep quality
Potential protection against dementia and Alzheimer's
Recommended Daily Amounts
Important Note:
Lithium does NOT have an established Recommended Dietary Allowance (RDA) or Dietary Reference Intake (DRI) because it's not classified as an essential nutrient by regulatory agencies.
Typical Dosing Ranges:
Nutritional Supplements (Over-the-Counter):
Common dose: 5-20 mg elemental lithium daily
Low dose: 1-5 mg daily
Lithium orotate: 120-150 mg (delivers ~5 mg elemental lithium)
Pharmaceutical Lithium (Prescription Only):
Acute mania: 900-1,800 mg daily (divided doses)
Maintenance: 600-1,200 mg daily
Target blood level: 0.6-1.2 mEq/L (acute), 0.4-0.8 mEq/L (maintenance)
These are NOT interchangeable - prescription lithium requires medical supervision and blood monitoring.
Food Sources
Lithium occurs naturally in varying amounts in:
Water Sources:
Drinking water (varies by geography: 0.001-0.2 mg/L)
Mineral water (some brands contain higher amounts)
Areas with naturally high lithium in water show lower suicide rates
Food Sources:
Grains and grain products
Vegetables (tomatoes, cucumbers, cabbage)
Legumes
Dairy products
Meat and fish
Mushrooms
Eggs
Note: Food sources provide micrograms to low milligrams of lithium daily. Exact content varies based on soil lithium levels where foods are grown.
Supplementation Guidelines
Nutritional Lithium:
Typical Supplement Forms:
Lithium orotate: Most common, 120-150 mg tablets (~5 mg elemental)
Lithium aspartate: Less common alternative
Lithium chloride: Rarely used in supplements
Starting Recommendations:
Begin with 5 mg elemental lithium daily
Can increase to 10-20 mg if well-tolerated
Some practitioners use up to 30-40 mg for therapeutic purposes
Timing & Administration:
Can be taken morning or evening
With or without food (food may reduce mild stomach upset)
Evening dosing may enhance sleep benefits
Consistent timing helps maintain steady levels
Pharmaceutical Lithium:
MUST be prescribed and monitored by a physician
Requires regular blood tests to monitor levels
Narrow therapeutic window between effective and toxic doses
Typically divided into 2-3 doses daily
Synergistic Supplements
Take WITH Lithium:
For Neuroprotection:
Omega-3 fatty acids: Synergistic for mood and brain health
Vitamin B12: Supports neurological function
Folate: Works with B12 for mental health
Magnesium: Supports neurological function (but see interactions)
Vitamin D: May enhance mood benefits
For Overall Health:
Multivitamin: Ensures adequate cofactors
Antioxidants: Vitamin C, E, selenium for cellular protection
Probiotics: Gut-brain axis support
Beneficial Combinations:
Lithium + omega-3s for mood disorders
Lithium + B-complex for energy and cognition
Lithium + magnesium (with monitoring) for relaxation
Interactions & What NOT to Take
Important Drug Interactions:
Increases Lithium Levels (Risk of Toxicity):
NSAIDs: Ibuprofen, naproxen (acetaminophen is safer)
ACE inhibitors: Blood pressure medications (enalapril, lisinopril)
Diuretics: Especially thiazides (hydrochlorothiazide)
ARBs: Blood pressure medications (losartan, valsartan)
Decreases Lithium Levels (Reduced Effectiveness):
Caffeine: Large amounts increase lithium excretion
Sodium: High sodium intake increases lithium excretion
Theophylline: Asthma medication
Other Interactions:
SSRIs/antidepressants: May increase serotonin syndrome risk (usually safe but monitor)
Antipsychotics: May increase neurological side effects
Calcium channel blockers: Potential neurotoxicity
Supplements to Monitor:
Excessive sodium: Reduces lithium retention
Potassium-sparing diuretics: May increase lithium levels
High-dose vitamin D: May affect calcium metabolism
Substances That Affect Lithium:
Alcohol: Increases dehydration risk and side effects
Excessive water: Paradoxically can dilute lithium levels
Dehydration: Dramatically increases lithium levels and toxicity risk
Who Should Take Lithium
Pharmaceutical Lithium Candidates (Prescription):
Individuals diagnosed with bipolar I disorder
People with bipolar II disorder with severe mood swings
Those with treatment-resistant depression (augmentation)
Individuals with schizoaffective disorder
People with chronic suicidal ideation
Those with cluster headaches (sometimes used)
Nutritional Lithium Candidates (Supplements):
Individuals seeking mood support
People with family history of mood disorders
Those experiencing mild depression or anxiety
Individuals interested in neuroprotection and healthy aging
People with sleep difficulties
Those with high stress or irritability
Individuals seeking cognitive support
Who Should AVOID or Use Caution
Absolute Contraindications:
For Pharmaceutical Lithium:
Severe kidney disease or impaired renal function
Severe heart disease or recent heart attack
Dehydration or significant electrolyte imbalances
Pregnancy (especially first trimester) - risk of Ebstein's anomaly
Breastfeeding (lithium passes into breast milk)
Addison's disease
For All Lithium Use:
Anyone unable to maintain adequate hydration
Individuals with significant kidney problems
Those with severe sodium imbalances
Use Extreme Caution:
Elderly individuals: More sensitive to effects, higher toxicity risk
Thyroid disorders: Lithium can worsen hypothyroidism
Diabetes insipidus: May be worsened by lithium
Epilepsy/seizure disorders: Lithium may lower seizure threshold
Parkinson's disease: May worsen tremor
Psoriasis: Lithium may trigger flares
Myasthenia gravis: May worsen symptoms
Monitor Closely:
People taking multiple medications
Those with fluctuating hydration status
Individuals with electrolyte imbalances
Anyone with a history of kidney stones
Those planning surgery (may need to discontinue)
Deficiency Symptoms
Important: Lithium is not officially recognized as an essential nutrient, so true "deficiency" is debated.
Potential Signs of Low Lithium Intake:
Mood instability or irritability
Difficulty managing stress
Poor sleep quality
Cognitive difficulties
Reduced longevity (population studies)
Higher rates of violence and suicide (epidemiological data)
Population Evidence:
Areas with naturally higher water lithium show lower suicide rates
Some research suggests trace lithium supports brain health
Possible increased rates of mood disorders in low-lithium areas
Note: These associations don't prove lithium deficiency causes these issues, but suggest potential benefits of adequate intake.
Toxicity Symptoms
Lithium Toxicity is Serious and Requires Medical Attention
Mild Toxicity (Blood level 1.5-2.0 mEq/L):
Nausea and vomiting
Diarrhea
Fine hand tremor
Muscle weakness
Increased thirst and urination
Drowsiness or lethargy
Moderate Toxicity (Blood level 2.0-2.5 mEq/L):
Confusion and disorientation
Slurred speech
Blurred vision
Coarse tremor
Muscle twitching
Unsteady gait (ataxia)
Increased deep tendon reflexes
Severe Toxicity (Blood level >2.5 mEq/L):
Seizures
Coma
Cardiac arrhythmias
Kidney failure
Death (if untreated)
Chronic Side Effects (Even at Therapeutic Levels):
Hypothyroidism (10-20% of users)
Weight gain
Cognitive dulling ("lithium fog")
Tremor
Increased urination (polyuria)
Kidney damage (long-term use)
Acne or psoriasis worsening
Nutritional Lithium Toxicity:
Much less common at supplement doses (5-20 mg), but possible if:
Taking excessive doses
Dehydrated
Combining with medications that increase lithium levels
Kidney impairment
If taking pharmaceutical lithium, toxicity can occur from:
Dehydration
Starting interacting medications
Kidney problems
Excessive dose
Reduced sodium intake
Special Considerations
Pregnancy & Breastfeeding:
Pharmaceutical lithium: Category D - known risk of birth defects
Ebstein's anomaly: Heart defect risk (especially first trimester)
Breastfeeding: Lithium passes into milk - avoid or use with extreme caution
Nutritional lithium: Insufficient safety data - best avoided
Kidney Function:
Essential monitoring: Kidney function tests before starting and regularly during treatment
Long-term effects: Can cause chronic kidney disease with years of use
Hydration: Critical to maintain adequate fluid intake
Nephrogenic diabetes insipidus: Lithium can impair kidney's water conservation
Thyroid Function:
Monitor regularly: TSH levels should be checked every 6-12 months
Hypothyroidism: Occurs in 10-20% of lithium users
Goiter: Thyroid enlargement can occur
Treatable: Usually managed with thyroid hormone replacement
Monitoring Requirements for Pharmaceutical Lithium:
Regular Blood Tests:
Lithium blood levels (initially weekly, then every 3-6 months)
Kidney function (creatinine, BUN, eGFR)
Thyroid function (TSH, T4)
Electrolytes (sodium, potassium)
Complete blood count
Calcium levels
Timing of Blood Tests:
12 hours after last dose
Before morning dose
At steady state (after 5 days on stable dose)
Nutritional Lithium Monitoring:
Generally doesn't require blood monitoring at low doses
Consider baseline kidney and thyroid tests if using long-term
Monitor for any side effects
Diet Considerations:
Maintain consistent sodium intake: Fluctuations affect lithium levels
Stay well-hydrated: Aim for 8-10 glasses of water daily
Moderate caffeine: High intake increases lithium excretion
No severe calorie restriction: Can affect lithium levels
Salt Intake:
Don't restrict salt: Can cause lithium toxicity
Don't suddenly increase salt: Can reduce lithium effectiveness
Keep consistent: Steady sodium intake maintains stable lithium levels
Special Populations
Athletes & Active Individuals:
Dehydration risk: Intense exercise requires extra caution
Electrolyte loss: Sweating affects sodium and lithium balance
Hydration protocol: Drink extra fluids before, during, after exercise
Consider lower doses or avoid pharmaceutical lithium if very active
Elderly:
Lower doses needed: Reduced kidney function and body water
Higher sensitivity: More prone to side effects and toxicity
Careful monitoring: More frequent testing recommended
Drug interactions: Often taking multiple medications
Mental Health Considerations:
Not a cure: Lithium manages symptoms but doesn't cure bipolar disorder
Compliance critical: Stopping abruptly can trigger severe mood episodes
Therapeutic relationship: Regular psychiatrist contact essential
Suicide prevention: Lithium has strongest evidence for reducing suicide risk
Summary & Key Takeaways
Lithium exists in two very different contexts: high-dose pharmaceutical lithium for serious mental health conditions and low-dose nutritional lithium for general wellness. Pharmaceutical lithium is a powerful, potentially life-saving medication that requires careful medical supervision, regular blood monitoring, and attention to hydration and drug interactions. Nutritional lithium supplements are generally safer at low doses but still require caution, especially regarding kidney function and medication interactions.
Bottom Line for Pharmaceutical Lithium: Only use under psychiatric care with regular monitoring. The benefits for bipolar disorder are substantial, but the risks of toxicity and side effects require vigilance. Never start, stop, or adjust doses without medical supervision.
Bottom Line for Nutritional Lithium: May offer mood and neuroprotective benefits at low doses (5-20 mg) with relatively low risk for most healthy individuals. Stay well-hydrated, be aware of medication interactions, and consider monitoring kidney and thyroid function if using long-term. Consult healthcare providers, especially if taking any medications or have existing health conditions.
Most Important Safety Rule: Adequate hydration is critical for anyone taking any form of lithium. Dehydration is the most common trigger for lithium toxicity.