
Should We All Take a Bit of Lithium? - peteretep
http://www.nytimes.com/2014/09/14/opinion/sunday/should-we-all-take-a-bit-of-lithium.html
======
tokenadult
The article points out

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.

[1] [http://www.amazon.com/Kay-Redfield-
Jamison/e/B000AQ1IC8](http://www.amazon.com/Kay-Redfield-Jamison/e/B000AQ1IC8)

------
hammock
The "benefits" of lithium come at a cost, which this article doesn't really
address. Lithium evens out your emotions, good and bad, some describe it as
"turning into a soulless robot." That could mean a more docile society (the
legal, behavioral, etc benefits described) but sounds pretty close to THX 1138
to me.

~~~
fifthesteight
I am bipolar. What you describe is why it's a "hard sell" to patients with
mood disorders.

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.

~~~
nutate
Over the past 14 years I've taken Lamictal, Lithium, Depakote, Seroquel,
Zyprexa, Geodon, etc. I still take the first 3. I also got a masters, a PhD,
recorded 3 albums with my band, played on plenty of others and worked on
plenty of creative outputs (including programming).

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. :)

~~~
jonahx
Thanks for sharing your experience. I am curious about the hospitalization for
mania. If you don't mind saying, what happened exactly? Were you so "up" that
you were taking dangerous risks? What types of behavior does mania induce that
make it a threat?

~~~
mantis369
In my case, delusions, paranoia, and the occasional inappropriate remark that
could be construed as homicidal or suicidal ideation. Depression genuinely
caused the latter ideation.

Lithium is a very harsh mistress, but if you have type 1, which is akin to
emotional epilepsy, she will bring you to heel.

------
jrapdx3
Good timing. It happens I'm going to Ashland, OR next week. The town is famous
for the Shakespeare Festival (world-class performances) and Lithia Park. The
latter is a natural lithium containing mineral water source. It's easy to
sample, just a short stroll from the Elizabethan theater, a drinking fountain
bubbles up the spring water.

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...](http://socialcapitalreview.org/seattle-region-ranks-2nd-
of-33-in-u-s-suicide-attempts/)

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.

~~~
klodolph
> distilled water is acidic

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.

~~~
nyan_sandwich
The reason given was leeching. Neutral is not good enough for that sometimes;
you need slightly basic. Some things will corrode at pH 7, but not higher.

Good call though; distilled water is neutral.

~~~
ams6110
Distilled water being very low in dissolved ions will be more prone to picking
up metal ions from pipes than water that already has a natural/normal level of
dissolved ions. So in that way it is more "corrosive" than ordinary tap water.

------
efm
The original post has bad math.

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](http://www.gwern.net/Nootropics#lithium)
has a significant number of references to the literature on lithium, and is
worth reading.

~~~
meowface
Gwern's writeups on nootropics are some of the best you'll find on the
Internet.

Honestly, his writeups on most things are pretty spot on.

~~~
jonnathanson
Gwern's writings on nootropics are particularly fascinating. They read like
the works of a mad scientist (in a good way). Erudite, meticulous, and also a
tiny bit reckless. Gwern treats himself like a human guinea pig, then
documents and analyzes the results more carefully than I've seen in some
research papers. The whole process, furthermore, reads like a dialogue between
Gwern and the reader. To be more precise, it reads like a dialogue between
Gwern and Gwern's imagined idea of a highly intelligent reader -- a reader
whose place you find yourself wanting to fill.

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.

~~~
meowface
Couldn't have said it better myself.

------
learc83
I live about 3 miles away from Lithia Springs, but I can't seem to find any
information online about how much lithium is actually in our drinking water.

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.

~~~
morganvachon
I'm just inside Paulding County with a Powder Springs address, and that's who
I pay my water bill to, but the yearly water quality reports I get come from
Cobb County. It makes me wonder if Lithia Springs even gets their municipal
supply from the spring, or from a Douglas County source.

~~~
learc83
> It makes me wonder if Lithia Springs even gets their municipal supply from
> the spring, or from a Douglas County source.

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...](https://www.google.com/maps/@33.8005688,-84.6403093,3a,75y,119.32h,87.77t/data=!3m4!1e1!3m2!1sbaehH8WENLgRKMsGz_NFzA!2e0)

~~~
morganvachon
Thanks, I've never actually been to the spring itself, though we drove by
there just today playing Ingress.

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.

~~~
ryandvm
People play Ingress?!

------
DanBC
Modern chemical analysis is exquisitely sensitive.

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](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.

------
morganvachon
I live just a couple of miles from Lithia Springs, Georgia, and oddly enough
I've never seen "Lithia Water" on sale anywhere around here. I suppose it gets
bottled and sold to retailers in other states.

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.

------
Xcelerate
> The authors discovered that people whose water had the least amount of
> lithium had significantly greater levels of suicide, homicide and rape than
> the people whose water had the higher levels of lithium. The group whose
> water had the highest lithium level had nearly 40 percent fewer suicides
> than that with the lowest lithium level.

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?

~~~
lutusp
> 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.

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.

------
jeffdavis
Mostly a reasonable and interesting article. But when you talk about adding
something psychoactive to the drinking water, it's just a horrible idea.

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.

~~~
DanBC
> But when you talk about adding something psychoactive to the drinking water,
> it's just a horrible idea.

Should we remove trace amounts of lithium from water in areas where it's
naturally occurring?

~~~
jeffdavis
No, I think you missed my point. Humans can't be trusted with the power to add
mind-altering substances to the drinking water. Once someone figures out how
to use it to their advantage, they will.

~~~
DanBC
But won't those same people just exploit the naturally occuring trace lithium?

Or is it not about lithium but the principle of adding stuff to water?

~~~
jeffdavis
Well, people will notice if concentrations change unless there is a real
conspiracy. But if it's declared "good" to add something to water, it's much
easier to manipulate the dosage.

------
afro88
If there is a concrete correlation between trace amounts of Lithium in the
water supply and lower suicide rates, surely there are other effects? The
studies done seem quite one sided to me (or more likely, this article is). For
serious consideration, not only do more studies have to be undertaken for
other cities, but other factors have to be measured as well. Other
psychological problems, rate of divorce, physical activity (sport etc),
unemployment, debt, other drug use, education etc. Perhaps there's a lower
incidence of suicide because people are much less active? Unemployed, no
ambition, but not enough drive to end it all as well?

~~~
lutusp
The answer is that, as one moves into more behaviors and more detail, the
chance to meaningfully correlate outcomes with lithium exposure becomes more
difficult. Also, because no one knows why those correlations exist (why
lithium has the effect it does), it's not possible to turn a correlation into
a rigorous, scientific cause-effect relationship.

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.

------
sethbannon
"But there are undoubtedly other reasons for its neglect. Pharmaceutical
companies have nothing to gain from this cheap, ubiquitous element."

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.

~~~
andylei
this just doesn't make sense. people sell _bottled water_! why can't they sell
lithium?

~~~
lutusp
Because bottled water doesn't have real or imagined therapeutic properties,
and lithium does. Eventually someone unfamiliar with the rules will advertise
a lithium/water product as having medical effects, and that will end the game
(advertising medical benefits is a no-no without both research backing and FDA
approval).

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.

~~~
andreasvc
I disagree. There is a market for supplements, as long as they walk a careful
line of avoiding the promise of any medical benefit. Lithium could be sold
this way, in low dosages ("Lithia Springs water"), but it's probably not
allowed? I remember that 7-up once contained lithium, but it was banned, even
though the amount was very small.

BTW: There is indeed an annoying level of unnecessary downvoting going on.

~~~
gwern
Lithium is already sold as a supplement. If you want to run out and buy eg
lithium orotate, you certainly can. It's cheap too.

~~~
ozy23378
And bulk analytical-grade lithium carbonate, sulphate and citrate not marketed
for human consumption are equally easy to acquire and even cheaper.

------
vesche
An interesting analysis from a self study if you haven't read it already:
[http://www.gwern.net/Nootropics#lithium](http://www.gwern.net/Nootropics#lithium)

------
xtrm0
[https://www.youtube.com/watch?v=pkcJEvMcnEg](https://www.youtube.com/watch?v=pkcJEvMcnEg)

------
falconfunction
Sounds like the pseudo science that kick starts 'end of the whole mess' by
Stephen king.

------
rectangletangle
[http://en.wikipedia.org/wiki/Lithium_(medication)#Side_effec...](http://en.wikipedia.org/wiki/Lithium_\(medication\)#Side_effects)
The dosages required to achieve "beneficial" psychoactive effects will
probably result in adverse side effects in a significant portion of the
population. Lithium should be prescribed by a doctor on a case by case basis,
not indiscriminately dumped into the water supply.

~~~
learc83
The article was talking about trace amounts, very far below the therapeutic
dosages that cause those side effects.

Trace amounts of lithium already occur naturally in many municipal water
supplies.

~~~
rectangletangle
The dose makes the poison, the higher PPM of lithium, the larger the
percentage of individuals that will be affected. Even if it affects a tiny
fraction of the population at the proposed concentrations, it's still unfair
to that demographic. Would you wan't to have to buy special non-lithium
supplemented water?

------
jessaustin
Using the word "millenniums" twice in an article the topic of which is not
idiosyncratic diction is obnoxious.

~~~
desdiv
Both Merriam-Webster and Oxford says it's acceptable:

[http://www.merriam-webster.com/dictionary/millenniums](http://www.merriam-
webster.com/dictionary/millenniums)

[http://www.oxforddictionaries.com/definition/english/millenn...](http://www.oxforddictionaries.com/definition/english/millennium)

------
steveplace
No.

------
scrame
Absolutely fucking not.

------
ksec
Lithium is naturally occurring? Wiki seems to suggest otherwise.

~~~
gus_massa
In some place, running water has more lithium. For example, there was a recent
study that correlates the suicide rates with the content of lithium in water
in some cities of Japan:
[http://bjp.rcpsych.org/content/194/5/464.full](http://bjp.rcpsych.org/content/194/5/464.full)

------
lutusp
Quote: "But there are undoubtedly other reasons for its neglect.
Pharmaceutical companies have nothing to gain from this cheap, ubiquitous
element."

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...](http://www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fjournal.pmed.0050045)

"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.

