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 Lithium Orotate 
(started 1/2014; co-written by MS3 Sarah Bobnick) 

Summary: 

1.       Low-dose lithium, and ultra-low-dose lithium, can have tremendous value for some people. 

2.       The limited research available suggests that lithium orotate could be riskier to kidneys than regular lithium.

3.       The idea that lithium, given as the orotate version, reaches the brain better than regular lithium, has not been clearly demonstrated.

4.       Therefore there is no clear reason to use lithium orotate.  It has no clear evidence for superiority over regular lithium, and might have more risk.  The only reason it continues to get any attention at all is because of the marketing efforts of those who profit from it.

More below:


What is lithium orotate?

The regular form of lithium, available by prescription, is lithium carbonate. This is plain old lithium, combined with carbonate to make a solid. It can also be combined with orotate to make a solid.

Once there was a claim that the orotate version delivered lithium to the brain more effectively. And therefore it could be given at much lower doses than regular lithium, yet still provide benefit.  Research in support of this claim is very old and very limited.

Lithium orotate is marketed as a dietary supplement and so does not require regulation by the Food and Drug Administration.  Because it is not regulated, those who sell it can make claims about its benefits without much restriction.  Let the Buyer Beware!

Benefits of low-dose lithium

Full-dose lithium can cause side effects such as tremor, and diarrhea.  If people get those side effects, they often want to stop taking it (they actually ought to start by talking to their docí and then turning it down a little bit). These and other high-dose effects have given lithium a bad reputation.  But low-dose lithium can still provide numerous benefits:   

1. Antidepressant add-on

Lithium can add to the antidepressant effects of other treatments (e.g. exercise, psychotherapy, light therapy, or antidepressant medications).Bschor 

2. Anti-anxiety effects

Lithium, even at low doses, can help people pull out of mixed states (combination of depression and agitation/anxiety/irritability and/or sleep disturbance). 

3. Possible anti-Alzheimerís effect?

Multiple recent studies are suggesting that for someone who is likely to develop Alzheimer's disease, very-low-dose-lithium might slow their progress toward that currently-untreatable disease. In addition to several lines of research which support this idea, there has even been a specific trial testing lithium in this role. Forty-five patients with early signs of possible Alzheimer's disease were randomized to either lithium or placebo. Those who received lithium showed significantly less worsening of their cognitive abilities (almost none) compared to those who received placebo, over the following year.Forlenza 

Evidence for risk from lithium orotate

In 1979, one of the world's most respected lithium researchers , Mogens Schou, studied the lithium orotate approach and found (in rats) that it seemed to produce more kidney damage than regular lithium. That was the last time lithium orotate was studied in a rigorous way.

(One woman did manage to get lithium toxicity from lithium orotate, but that was after ingesting 18 pills at once. Pauze At least this shows that some lithium orotate pills from the internet really do contain a significant amount of lithium. )

Why is lithium orotate even considered ? By anyone?

I think there are 2 reasons for this.

1.  Is it better than lithium carbonate?

A glimmer of evidence, from 2 studies in the 1970s, suggested lithium orotate might deliver lithium to the brain better than regular lithium (lithium carbonate). 

The first, the one that started all this, was by Hans Neiper (no abstract online for is 1973 paper; a summary by a psychologist is in here).  Nieper made broad claims for the benefits of low-dose lithium (many of which I agree with) but attributed them to the orotate approach.  He thought the orotate allowed lithium to reach and stay in the brain better than lithium carbonate.  One study agreed. Kling  One study did not. Smith

Why hasnít it been studied more? Some might say this is because Western medicine is only interested in making money and that by around this time, there was little money to be made with pharmaceutical lithium.  However, in my opinion, if that was an accurate explanation, we would not see the remarkable number of studies that have been produced recently on fish oil or N-acetylcysteine, which also are not money-makers for Pharma.   JP link those pages

Instead, I think the research came to a halt because of Dr. Schouís findings noted above. JP link Unfortunately, that was only a single study, in rats. But it was enough to put a dagger through further research on lithium orotate. As far as we know at this point, it might still be possible that lithium orotate is not really more dangerous, in humans, than lithium carbonate. One study in rats is not enough to really know. However, it does leave the burden of proof upon those who would promote lithium orotate to demonstrate its safety. Unfortunately, doing that right would take a lot of money. I think that is why we are stuck.

2.  Follow the money (once again)

The other reason there is so much noise on the Internet about lithium orotate is because of all of the marketing that it receives from companies which are profiting from selling it. I hope that you, gentle reader, have learned not to trust those who are making money on something to give you accurate information about it.

(How much of this stuff have I actually read?)
I have read the Smith paper (
online). I have not read Kneiperís 1973 manuscript, instead relying on the online summary by the psychologist who does appear to have read it (here).  I have read abstracts only for all the other cited studies.

Why havenít  I looked into this more? Studied the full articles, for example? Because at this point the whole issue is stuck, as described above, on the one study that showed greater risk with orotate than with regular lithium. Even though itís only one study, it was by a very reputable source.  Thus we now need further evidence showing safety, or  a lot more evidence for greater benefit from lithium orotate, before anyone should consider using the orotate form. Besides, for low-dose lithium, we can just use regular lithium carbonate, 150 mg, which bothers very few people. If someone made a smaller one, I would probably use it sometimes, but I don't really need it. (One can use a liquid lithium, lithium citrate, and make much smaller doses than 150 mg, but again, I donít really need it so I very rarely use this approach).