‘I Don’t Believe in God, but I Believe in Lithium’

Lithium, as medication, has been a benchmark of my life, though in a different way than portrayed in the nicely written article.

When I was in school back in the 60's, I had the chance to see the healing effects of lithium before it was approved here in the US in 1970. I saw a man in a florid manic state dramatically improve in two week's time, kind of magical and it left a lasting impression on me.

A few years later I happened to be walking in town, and a man stopped me. "I know you. You were one of those students there when I was in the hospital." Only then did I know who he was. I asked how he was doing. He said "I'm doing quite well. Lithium saved my life and I'm still taking it."

Since then I've had the responsibility of treating many people with mood disorders, and I didn't forget what I'd learned. Anyway, lithium is still a godsend for many people, but of course it really isn't a magic bullet, nothing is.

Like all medications it can produce bad effects. I've seen that happen too. Renal failure is a risk as the article points out. Careful monitoring can prevent some bad outcomes, though not all. Doing whats best requires utmost dedication by patient and doctor to the cause of stability and quality of life.

In the words of Spinoza, "all things excellent are as difficult as they are rare." Success is possible, we just have to find the courage and strive to get there.

I was reading some of your other comments, and what a pleasant surprise to another Portland psychiatrist on HN. Small world.

I've never taken lithium nor am I am psychiatrist, however it isn't known yet how lithium works - is it? I know they're better at understand the impact it has on the brain and function - but not the why it causes that?

I find it amusing to quote Spinoza whilst talking about such philosophical things like lithium and mental state.

A study in Japan has shown a sample population to be less likely to commit suicide after drinking tap water containing lithium.

Notably, there is enough lithium in the groundwater in certain areas of the US that this "study" has been happening for a long time. El Paso, Texas has high naturally occuring lithium in the groundwater, and is widely reputed to have less violence than comparable cities with less lithium in their water. I haven't read the whole thing, but remarkably, a recent paper seems to have shown this to be true, at least for suicide mortality.

Lithium in the public water supply and suicide mortality in Texas (Blüml et al, 2013)

  There is increasing evidence from ecological studies that 
  lithium levels in drinking water are inversely associated 
  with suicide mortality. Previous studies of this 
  association were criticized for using inadequate 
  statistical methods and neglecting socioeconomic 
  confounders. This study evaluated the association between 
  lithium levels in the public water supply and county-based 
  suicide rates in Texas. A state-wide sample of 3123 lithium 
  measurements in the public water supply was examined 
  relative to suicide rates in 226 Texas counties. Linear and 
  Poisson regression models were adjusted for socioeconomic 
  factors in estimating the association. Lithium levels in 
  the public water supply were negatively associated with 
  suicide rates in most statistical analyses. The findings 
  provide confirmatory evidence that higher lithium levels in 
  the public drinking water are associated with lower suicide  
  rates.

https://www.gwern.net/docs/lithium/2013-bluml.pdf

Edit: I just realized that the Op Ed linked from the main article mentions the same evidence, although without reference to that particular paper: http://www.nytimes.com/2014/09/14/opinion/sunday/should-we-a...

I wonder if the levels of elements in tap water around the world would explain some cultural differences.

It’s just hard to find causation here, while correlation is simple to prove

I believe you meant behavioral differences.

Bacteria, genetics, terrain, etc. would be great to study.

Yes let's drug all the population. Soma anyone?

The fiendish fluoridators are after us again! It depends whether you would view this as imposing an artificial medication or just correcting a dietary deficiency.

Lithium, like lead, is an element, not a drug. And lithium, like lead, has a significant environmental impact on the general population -- specifically, on behavior. And the current lack of lithium in our environment is detrimental to us, and not what we evolved for, just as the past prevalence of lead within our environment was.

I'm a psychiatrist, and I prescribe lithium quite a bit. It really is the gold standard for treating Bipolar I Disorder.

Aside: If you are a person who uses the word "bipolar" as a synonym for moody or indecisive, I hope reading this will help you understand what actual bipolar mania looks like.

As a developer who has been prescribed this after a fit of what could only be described as 'true mania' in my college years, I consider this statement somewhat disturbing from a personal perspective. I quite literally functioned as a zombie while on this nightmare of a substance. I ended up opting to spend double digit hours a week in therapy and implementing a system of Cognitive Behavioural Therapy over living my life in a cloud of misery after over 4 months on it. I'd rather feel and have to keep myself in check over function as a zombie barely capable of running a cash register or reading a real book.

For reference: I've never had a mania or true low since working with it this way, and if I did I would immediately seek a medicated solution knowing the severity of the situation. But, I've managed to hold a full time job, excel my career more than I thought possible, and generally be quite well physically professionally and mentally without it.

Yet is it any wonder patients end up going off it so much? Her description sounds fucking awesome. What sane person wouldn't want to experience that kind of thing? Limitless energy, godlike feeling? In fact, apart from the depression and life-threatening stuff, why wouldn't you mostly wanna be like that? I suppose if you have to hold down a job an "be an adult", meh, OK you've got no choice. But if you're otherwise set? Bring it on.

Depakote, yuck. Gain weight, feel like shit. Or others that remove all desire (except hunger).

It's sad that medicine currently has no attractive offers for strong mental disorders like this.

On the other hand, a non-negligible reason for this confusion is that the standard nomenclature for many psychiatric conditions is simply quite ambiguous. Bipolar? Borderline? The former implies there's two fixed states that are evenly transitioned to and from, where the latter implies... nothing immediately discernible.

I worked with someone who is bipolar. There's no way you could confuse her problem with that of a healthy person who's just too emotional. She needed lithium to have the semblance of a normal life, and even then when she started to get too bubbly we knew someone was going to have to cover her job for a week or two.

Any other favorite examples of disorders whose names get misused as metaphors? (I guess "OCD" is a common one -- and indeed "depressed" and "schizophrenic" too.)

"OCD", too, is sadly overused.

Ever since reading the referenced op-ed from the New York Times, I have been curious about the effects of low dosages of lithium. If a large dose can counteract bipolar disorder, it seems reasonable that a low dosage would have at least some amount of calming effect (which is what the NYT article claimed, with reference to some studies done on populations with naturally high occurences of lithium in their water supply).

So about eight months ago I started taking a low dosage of lithium, in the form of drops added to my drinking water, in a dosage that amounts to about 2-3mg per day - similar to the amounts in naturally occurring high-lithium drinking water. (In comparison, therapeutic doses are several 100 mgs per day).

Anecdotally, it might just be placebo effect, but I do feel it has had some effect. I have always been a bit anxious, particularly socially, and I feel that has diminished over this period. However, this experiment coincides with a better exercise regimen, and also simply growing older, so it's difficult to 100% attribute the effect (if any) to the added lithium. It would be very interesting to see more studies on this.

If anyone's interested you can buy these drops as 'trace mineral drops' from the Great Salt Lake.

There was a study in Italy of a patient who was cured of a severe form of bipolar called rapid cycling bipolar with "darkness therapy". They locked him in a dark room for 14 hours a night and after a couple months his sleep and his mood stabilized. No medication.

http://psycheducation.org/treatment/bipolar-disorder-light-a...

I'm reminded of a previous NYT article about Lithium: http://www.nytimes.com/2014/09/14/opinion/sunday/should-we-a... https://news.ycombinator.com/item?id=8314188

Just be careful on long term lithium. Even when taken at the proper dosage it will destroy the kidneys, eventually leading to death. This is not as well disclosed/known as it should be.

Probably because it is extremely implausible: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2516429/

And let's be clear about this: you have claimed lithium "will destroy the kidneys, eventually leading to death". This is the claim you made, not some other unrelated claim, and it is wildly implausible.

A plausible but completely unrelated claim is, as reported in this paper: "lithium can be safely prescribed over a protracted period of time, even in elderly populations, but should be monitored closely under specialist supervision, to ensure early identification and management of adverse effects."

This proposition offers no support whatsoever to the claim that lithium "will destroy the kidneys, eventually leading to death". It is not evidence for it, it is contradictory to it.

I'm over-emphasizing this because I've too often seen people make wildly implausible claims like the one you have made and then try to claim that some totally unrelated but plausible claim like the one in this paper somehow supports their position. It does not. Your position is not in any way supported by a paper that directly contradicts it.

This is certainly well disclosed in the article!

He was alarmed at my combination of high creatinine levels, damaged kidneys and heart-attack-level blood pressure (185/130). At Mount Sinai Hospital, my doctor’s fears were confirmed in a matter of days: My kidneys were irreparably damaged, an ‘‘uncommon but not rare’’ side effect of long-term lithium use.

I wonder if things like bipolar disorder fall on a broad spectrum and a lot of people might not have very mild and perhaps undiagnosable mood disorders that might benefit from very low level lithium supplements. Is lithium supplementation a thing (can you buy it in "health food" stores) and is there any evidence of efficacy for non psychiatric cases?

There's definitely reason to believe it's on a "spectrum", and I seem to recall I've seen studies that suggest probably everybody is on some sort of months-long cycle (not always directly correlated to the calendar, which would be relatively uninteresting). Many creative people who squeeze their creativity dry as coders or artists or whatever have observed this seems to exist. I've noticed it myself, here's another person who recently observed it: http://www.shamusyoung.com/twentysidedtale/?p=26444

In people with pathological bi-polar disorder, it may be the case that rather than some sort of novel problem, it's just that the amplitude and the frequency can be much larger and higher, where "creativity" and "energy" shoot beyond the realms where either of those words quite properly applies anymore.

But in the end, we don't really know enough about the brain to be sure about this. A proper, correct model of the brain might be able to prove this by showing the drivers of such a long-term oscillation, but we're a long ways away from the requisite level of detail. Even with the suggestive studies it can only be called an interesting theory.

As I wrote in another comment, many health food stores carry 'trace mineral drops', which are (de-salted) concentrate from the Great Salt Lake. It contains trace amounts of lithium (as well as other 'trace' minerals like magnesium, chloride and sulfate). I know of at least a few cases where they have been prescribed for (and cured) involuntary spasms when trying to sleep after a hard exercise (horse riding), the effect in this case is from the magnesium.

You can also buy straight up lithium tablets which contain a slightly higher dose (5mg) than the recommended dosage of the drops (2-3mg).

The NYT article referenced in the OP and in other comments references 'evidence' in the form of studies of communities with naturally occuring high-lithium drinking water (lower rates of violence in general).

Apparently 7-up contained lithium citrate until 1950 for its mood stabilizing effects:

https://en.wikipedia.org/wiki/7_Up

Coke, on the other hand, lost its cocaine content much earlier, in 1903.

I live a few miles from the lithia springs that Lithia Springs GA is named after. I still haven 't been able to find out how much lithium there is in our tap water.

send it to an assay lab ?

I thought this was going to be an article about batteries and the quote would be attributed to Elon Musk or some other tech billionaire.

I was pleasantly surprised.

The title is really idiotic.

It is great that there's a way to improve the lives of these suffering people. Still, it scares me how little we know about how these drugs work (and by "we" I don't mean myself, but the summary state of human knowledge, as it appears to me) and that we still - at least as it looks to me, admittedly knowing very little on the subject beyond popular press - that we still rely mostly on luck and trial/error in figuring out how to mitigate mental illness. That sounds like we'd write code by just mostly randomly putting words together and then run through a battery of unit tests and see if something works. And if some unit test passed we'd declare that code a function implementing that unit test's functionality. I imagine you can get somewhere this way, but it's kind of scary we don't have something better.

Side rant:

Claiming that you don't believe in God is equally annoying as those sect guys knocking at your door. I do believe in God and I find the use of lithium in treating these illnesses a hope (with potential dead serious side effects: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4456600/) but not the potential meaning of life (?! how can you compare lithium with the notion of God?!).

Lithium gives her [her] life back, in much the same you believe god gave you yours.

IIRC the main problem with lithium is the narrow therapeutic window, hence potential toxicity. But I had no idea it was that good. Actually reading studies I wasn't quite sure of many drugs psychiatrists prescribe, especially serotonin re-up takes... But out of experience they seem to work in many cases.

> After I was admitted to the institute's adolescent ward, I thought the nurses and doctors and therapists were trying to poison me.

Well, they kinda are. Theraputic doses of lithium are disturbingly near toxicity levels.

Prescribing a medication with a narrow therapeutic window is not the same as intentionally trying to poison someone.

You could see mania as our true state, the one we are most happy in and you could see society trying to take that away so that we can be useful and productive.

It is not hard to spin anything into a conspiracy.

| i do believe in Gd, but i do not believe in lithium.

Please, everyone, let's stop talking such nonsense and missense. There's a framing error at play here, at a very fundamental level, and a whole field has gone down this rabbit hole for far too long. There is no such illness called "manic depression"; there is a symptome called "hope-despair spectra dysregulation disorder". The phrase "manic-depression", like the word "harassment", is a confusing misnomer almost deliberately invoked by a langauge switcheroo, mostly by professionals who are never trained in the original humanisms from which the word originated and is imparted and imported. As with harassment, which is more clearly expressed as "exhaustion", the term "mania" is more clearly expressed as an assessed "unreasonable and/or extreme hope, leading to reckless energy or cognitive chain investments or behavioural drivers". The term "depression" is simply a prolonged despair, wherein a person is seen to be desperate for air. Psychiatrists and psychologists who speak of manic depression as something more than a persistent "hope-despair dysregulation" are usually, in my experience, blowing smoke, and owe a duty to assess whether the hope-despair complex is the result of illogic, illmotion, or both, and whether that illogic, illmotion, or both is exogenous or endogenous. The postulations in the DSM are not credible, as the Director of NIMH, the National Institute of Mental Health, asserts in pointing out that the field of psychiatry is terrible at identifying causes, and dresses up symptom complexes and symptomologies to look like mechanical medical dis-eases. There are very few diagnoses that psychiatrists can do, and calling "hope-despair spectra dysreg disorder" (or, manic depression, as the DSM calls it) a diagnosis is, in my humble opinion, a fraudulent claim. It's not a diagnosis... it's a symptosis, or [symp]tomosis.

It's also completely imprecise and inaccurate, rather like saying, "@phren0logy has a cough", rather than saying "@phrenology has a rhinovirus" .

Hope-Despair Dysregulation Disorder (HD3), from.... Manic = A state of prolonged hope Depression = A state of prolonged despair

It's only natural that We should have evolved, have had revealed, been given, and overwritten and at times, overridden environmental and social expectancies, and that those should altar the pattern of our hope and despair. The persistence of these patterns can, in the eyes of another, be seen as "abnormal" and an "unwanted deviance from socially integrated expectancy patterns". The response pattern from terrapists is to feed a salt pill to the patient as a placebo, in the place of a more obvious sugar pill, so that the patient returns regularly for talk therapy sessions or has a few weeks to stabilize their native sense of the statistics of life, wearing out their own misweighting of cued and observed probabilities. But... this same effect would happen if they were to be fed NaCO3, or NaCl. Lithium, i posit, has no effect other than as an off-grid placebo pill to give terrapists time to try to figure out the root cause and failure modes in cognition. i do not believe the statistical effects of natural experiments yet; i have not come across a convincing study yet, and it's my belief that study non-publication bias for disconfirmations on lithium's environmental effects will explain the rest.

As for what to do with people who are thinking about survival rather than thriving, and considering survival failure, tell them they are on the hope-despair dysregulation spectra, and ask them to consider how many years left they have until they reach 100 years old, and set that as their new age. 22? Your real age is not Your chronological age (cage) of 22; it is Your survivor age (sage) of 78. Reinforce it by teaching them the Periodic Element that their Steam Age corresponds to, in this case, Platinum, or Pt, and ask them to go for physical therapy by going out for a long run with a friend, or, if they have legal woes instead of psychiatric woes, arrange for them to speak with whoever it is that is the cause of their woes in a safe space, rather than aggravating or papering over the lack of ethical calmunity care.

Lastly, read Seligman's Flourish with them, and other works of positive, social, and cognitive bias psychology. The attempt to use diagnostic langauge in a root-cause-agnostic is fraudulent; please stop doing it. It causes far more damage than psychiatrists and other psycholory specialists take responsibility for, particularly as families, calmunities, and institutions abuse the indeterminacy, soft, nearly unfalsifiable nature of psychiatric labels as a means of social control for those they consider inconvenient gadflies suffering from too much institutionally-wrought despair.

Also, the DSM Criteria are foolish to apply against certain classes of the population. For instance, with hope-despair dysreg, one of the symptoms is written up as "Flights of Ideas", with some modifiers. Intellectuals and designers cultivate the capacity to undergo "flights of ideas". That's what these people do. Why would You count that as a bullet point toward psycholore.ical sympagnostics, when it is part of their professional duties? That just weakens the whole meaning of the sympagnostic for that whole sector of the population.

Those are my 2 calming sense on the problem. PERMA, Exercise, Resiliency Training, Socialization, Uninterrupted Purpose, Daily Progress all add up to an end to depression; talking to a blank face of a false friend with no power to convene the social world to determine and test the reality described may help tune, slow, or stop survival fail, but only for a time. Inverted ages (Pb-Ar) and Fundamental, sustained purpose mixed with calming human life stage activities will stabilize most, on a complete review of their ethics, i.e. their character. Lastly, if there's loneliness or a reflective solitude involved, You'll want to review and perhaps fix that as well, as the case requires.

Best wishes, everyone. Let me know if You're ever in need of a call to point out how many Years You'd be sacrificing should You go "Canary" prematurely. Reach out to me; i can help you Flag Sentinal instead of losing Your life to self-organized survival fails.

Lithium works well for my symptoms but I do not tolerate it. When I learned that it only reduces hospitalizations by half I stopped taking. I did just fine for six years but became psychotic in graduate school.

Since then Ive taken valproate which works well and so far I tolerate well. However there is significant risk to my liver. I take regular blood tests to watch for that.

Lately Ive been feeling physically ill, as if I have been poisoned. I dont know the cause but will request a liver function test this week.

I thought this was going to be about batteries.

I was hoping it would be an Elon Musk quote.

I thought the same thing. It would make an interesting annecdote in the article to talk about lithium ion batteries. I thought I read somewhere that China has a large stock pile of lithium.

Still, an good read.

Same here. Apart from that, I don't think God believes in her too.