Lithium: balancing mental and renal health

Identifying the neuropsychiatric health effects of low-dose lithium interventions: A systematic review

“…In practice, the appropriate dose will be determined by an individual's presenting symptoms, course of illness and concomitant treatments (Severus et al, 2008). It is also well understood that the clinical benefits of lithium, and the decision to continue treatment at standard doses, needs to be balanced against the potential harms such as renal impairment (Strawbridge and Young, 2022). However, the encouraging findings from some studies of low-dose lithium suggest that it may be a useful adjunct that is well tolerated, and the findings of this review may support individualised decisions regarding the choice of dose in those apparently benefitting at lower serum concentrations.…”

“…Thus far, a wide range of doses have been used across a small number of trials and although a meta-analysis suggested benefits that do not appear to vary substantially by dose, (Matsunaga et al, 2015) a study which used doses comparable to those in bipolar disorder did not show positive effects and reported poor tolerability. The rationale for the use of low-dose lithium in prevention as well as treatment of cognitive impairment (Strawbridge and Young, 2022) is pertinent to other areas, such as those at risk of mood disorders and/or suicidality where other lines of evidence suggest that prolonged exposure to trace lithium decreases suicide as well as homicide and dementia rates (Memon and Rogers, 2020). Given this and the extent to which suicide is a public health concern, it is surprising that so few studies have systematically examined lithium's effects on It is worth noting that the therapeutic potential of microdoses of lithium have been considered for indications beyond neuropsychiatric health, ranging from antiviral interventions (Rybakowski, 2022) to proposals that it should be considered as an essential micronutrient facilitating the functions of vitamins and folates (Schrauzer, 2002).…”

“…The purported benefits of lithium orotate in the typically advocated doses have not been the subject of meticulous scientific scrutiny. Whilst safety is implied from the elemental dose approximating to the higher end of environmental exposure combined with decades of wide self-administration in some communities, specific examination of the potential benefits and risks of lithium administered in orotate form (including consideration of the effects of the orotate anion itself) are warranted (Strawbridge and Young, 2022).…”

“…Lithium is the mainstay treatment for mood episodes in the context of bipolar disorder (Cousins et al, 2020), and not only has a robust evidence base for other mood disorders (Strawbridge et al, 2019;Young, 2017) but also reasonable evidence for its anti-suicide properties (Lewitzka et al, 2015) (which may be independent of its mood stabilising effect (Song et al, 2017)). Clinically therapeutic doses of lithium (as delineated in treatment guidelines) are associated with adverse effects such as renal and thyroid dysfunction (Strawbridge and Young, 2022), which can be mitigated or addressed through regular monitoring of blood monitoring. However, it is a concern for the vulnerable elderly when considering lithium as a putative treatment for people with Alzheimer's dementia, an area which is gaining momentum (Matsunaga et al, 2015).…”

Lithium: how low can you go?

“…While lithium does in some cases adversely affect renal function (particularly older people on long-term therapy (Tondo et al 2017 ), the risk of chronic renal illness may not be significantly increased in an overall lithium-treated group (Bosi et al 2023 ). An in-depth recent study reported high interindividual variation but steeper declines in estimated glomerular filtration rate (eGFR) explained by lithium use but also found wrongful clinical attribution of some chronic kidney disease (CKD) cases to lithium (Fransson et al 2022 ) which may have increased other records-based studies’ estimates (Strawbridge and Young 2022 ). Relatedly, long-term lithium use can also induce nephrogenic (but not central) diabetes insipidus (Grünfeld and Rossier 2009 ) and more innocuously, polyuria (Gitlin 2016 ).…”