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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 14 of 14. This is the beginning of the thread.
Posted by undopaminergic on January 31, 2023, at 10:52:44
Hi all,
I'm mentioning this article because anti-suicidal effects of lithium is a current topic and I just read it myself. There is otherwise little or nothing novel in it, but it may perhaps serve as a brief introduction for the novice.
The statistics are interesting, and can be found in the first section of the article, after the abstract. For example: "the ratio of attempts to completed suicides among patients with bipolar disorder is 3 to 1, compared with 30 to 1 among the general population".
"Lithium Suicide Prevention: A Brief Review and Reminder"
https://pubmed.ncbi.nlm.nih.gov/30834169/
Full article: https://www.ncbi.nlm.nih.gov/pmc/articles/pmid/30834169/-undopaminergic
Posted by SLS on February 1, 2023, at 6:13:19
In reply to Lithium in suicide prevention -- short review, posted by undopaminergic on January 31, 2023, at 10:52:44
> Hi all,
>
> I'm mentioning this article because anti-suicidal effects of lithium is a current topic and I just read it myself. There is otherwise little or nothing novel in it, but it may perhaps serve as a brief introduction for the novice.How does lithium work to prevent suicide?
When I took lithium at high dosages, I felt passive. I wonder if passivity is a component of its anti-suicide properties.
- Scott
Posted by undopaminergic on February 1, 2023, at 8:27:14
In reply to Re: Lithium in suicide prevention -- short review » undopaminergic, posted by SLS on February 1, 2023, at 6:13:19
> > Hi all,
> >
> > I'm mentioning this article because anti-suicidal effects of lithium is a current topic and I just read it myself. There is otherwise little or nothing novel in it, but it may perhaps serve as a brief introduction for the novice.
>
> How does lithium work to prevent suicide?
>The article doesn't say. That's one of the reasons it left me wanting for more information.
> When I took lithium at high dosages, I felt passive. I wonder if passivity is a component of its anti-suicide properties.
>I think not, because lithium seems to exert an anti-suicidal effect even at doses lower than what is needed for mood stabilisation.
-undopaminergic
Posted by SLS on February 1, 2023, at 8:57:50
In reply to Re: Lithium in suicide prevention -- short review » SLS, posted by undopaminergic on February 1, 2023, at 8:27:14
Hi, UD
> > How does lithium work to prevent suicide?
> The article doesn't say. That's one of the reasons it left me wanting for more information.
> > When I took lithium at high dosages, I felt passive. I wonder if passivity is a component of its anti-suicide properties.
> I think not, because lithium seems to exert an anti-suicidal effect even at doses lower than what is needed for mood stabilisation.
Interesting. Passivity appeared for me at a dosage of 450 mg/day.
- Scott
Posted by SLS on February 1, 2023, at 9:11:45
In reply to Re: Lithium in suicide prevention -- short review » undopaminergic, posted by SLS on February 1, 2023, at 8:57:50
Suicide is often seen when someone just begins to respond to an antidepressant. When responding, one of the first things that occurs is an increase in mental energy. It appears before there is an improvement in mood. So, the result is that one still has the same reasons to commit suicide, but now has the energy to act on suicidal impulses that they hadn't had have the energy to act on previously. This period of increased risk often occurs between 2-3 weeks subsequent to the beginning of treatment. Because of this, a good psychiatrist will have their depressed patients come in once per week at the beginning of treatment.
- Scott
Posted by undopaminergic on February 1, 2023, at 9:54:12
In reply to Re: Lithium in suicide prevention -- short review » SLS, posted by SLS on February 1, 2023, at 9:11:45
> Suicide is often seen when someone just begins to respond to an antidepressant. When responding, one of the first things that occurs is an increase in mental energy. It appears before there is an improvement in mood. So, the result is that one still has the same reasons to commit suicide, but now has the energy to act on suicidal impulses that they hadn't had have the energy to act on previously. This period of increased risk often occurs between 2-3 weeks subsequent to the beginning of treatment. Because of this, a good psychiatrist will have their depressed patients come in once per week at the beginning of treatment.
>
>
> - ScottI've heard of that before, but good summary!
-undopaminergic
Posted by Lamdage22 on February 1, 2023, at 14:51:49
In reply to Re: Lithium in suicide prevention -- short review » SLS, posted by SLS on February 1, 2023, at 9:11:45
I can say that I felt that 15 mg elemental lithium cut my suicidal thoughts down. I could leave the closed unit once and for all. I never returned.
It was 15 mg elemental lithium from a larger amount of Lithium Orotate. I think 375mg.
That is just an anecdote, I know.
Posted by SLS on February 1, 2023, at 17:26:01
In reply to Re: Lithium in suicide prevention -- short review, posted by Lamdage22 on February 1, 2023, at 14:51:49
Hi, Lamdage.
> I can say that I felt that 15 mg elemental lithium cut my suicidal thoughts down. I could leave the closed unit once and for all. I never returned.
>
> It was 15 mg elemental lithium from a larger amount of Lithium Orotate. I think 375mg.Interesting. What does elemental 15 mg of lithium convert to in lithium carbonate?
> That is just an anecdote, I know.
If the one anecdote is yours, then I guess n=1 is plenty enough.
- Scott
Posted by Lamdage22 on February 2, 2023, at 3:05:42
In reply to Re: Lithium in suicide prevention -- short review » Lamdage22, posted by SLS on February 1, 2023, at 17:26:01
> Hi, Lamdage.
>
>
> > I can say that I felt that 15 mg elemental lithium cut my suicidal thoughts down. I could leave the closed unit once and for all. I never returned.
> >
> > It was 15 mg elemental lithium from a larger amount of Lithium Orotate. I think 375mg.
>
> Interesting. What does elemental 15 mg of lithium convert to in lithium carbonate?I believe that is about 80 mg lithium carbonate. There are about 19mg of elemental lithium in 100mg lithium carbonate.
https://pubmed.ncbi.nlm.nih.gov/18072162/
Posted by SLS on February 2, 2023, at 9:13:07
In reply to Re: Lithium in suicide prevention -- short review, posted by Lamdage22 on February 2, 2023, at 3:05:42
Hi, Lamdage.
> >
> > > I can say that I felt that 15 mg elemental lithium cut my suicidal thoughts down. I could leave the closed unit once and for all. I never returned.
> > >
> > > It was 15 mg elemental lithium from a larger amount of Lithium Orotate. I think 375mg.> >
> > Interesting. What does elemental 15 mg of lithium convert to in lithium carbonate?
> I believe that is about 80 mg lithium carbonate. There are about 19mg of elemental lithium in 100mg lithium carbonate.
> https://pubmed.ncbi.nlm.nih.gov/18072162/> > > I can say that I felt that 15 mg elemental lithium cut my suicidal thoughts down. I could leave the closed unit once and for all. I never returned.
> > >
> > > It was 15 mg elemental lithium from a larger amount of Lithium Orotate. I think 375mg.> > Interesting. What does elemental 15 mg of lithium convert to in lithium carbonate?
>
> I believe that is about 80 mg lithium carbonate. There are about 19mg of elemental lithium in 100mg lithium carbonate.
> https://pubmed.ncbi.nlm.nih.gov/18072162/> > If you can say that you are in remission, don't rock the boat - ever.
What are your concerns regarding lithium carbonate?
----------------------------
A Harvard study used lithium carbonate 300-600 mg/day as an add-on to fluoxetine (Prozac):
1. Fluoxetine 20 mg/day - The usual rate of response at this dosage.
2. Fluoxetine 60 mg/day - A much higher rate of response compared to 20 mg/day.
* This would be expected according to what is seen anecdotally today.3. Fluoxetine 20 mg/day + Lithium 300-600.
* Adding lithium 300-600 mg/day to fluoxetine 20 mg/day produced a rate of response somewhat higher than is normally seen with fluoxetine 20 mg/day monotherapy.4. Fluoxetine 60 mg/day + Lithium 300-600mg/day
* The addition of lithium 300-600 mg/day to fluoxetine 60 mg/day produced the highest rate of response, but the increase was not as high as was seen when the dosage of fluoxetine monotherapy was increased from 20 mg/day to 60 mg/day. In addition, the researchers found that adding lithium at 600 mg/day produced the lowest response rate. 450 mg/day of lithium produced the highest rate of response, but 300 mg/day came close.Personally, I thrive at 300 mg/day of lithium, but relapse pretty hard when I raise the dosage to 450 mg/day.
I guess the lessons to be learned here are:- The response rate to fluoxetine monotherapy at 60 mg/day is much higher than that seen at 20 mg/day. Unless side-effects are a consideration, one should not discontinue fluoxetine until a dosage of 60 mg/day is arrived at and allowed 2-4 weeks to produce results. The time period that one must wait for a therapeutic response to occur after a dosage increase of fluoxetine is longer than with other antidepressants. This is because the half-life of the active compounds is over a week. It takes longer to establish an equilibrium. I have never seen a loading-dose used for fluoxetine.
- When used as an adjunct to fluoxetine when treating depression, low-dosages are more effective than high dosages. Please note that if mania or rapid-cyclicity are to be controlled, the traditional dosages of lithium are necessary (900-1500 mg/day) or sometimes higher.
- Scott
Posted by Jay2112 on February 4, 2023, at 19:26:10
In reply to Re: Lithium in suicide prevention -- short review » undopaminergic, posted by SLS on February 1, 2023, at 6:13:19
> > Hi all,
> >
> > I'm mentioning this article because anti-suicidal effects of lithium is a current topic and I just read it myself. There is otherwise little or nothing novel in it, but it may perhaps serve as a brief introduction for the novice.
>
> How does lithium work to prevent suicide?
>
> When I took lithium at high dosages, I felt passive. I wonder if passivity is a component of its anti-suicide properties.
>
>
> - Scott
>Lithium in low doses, I think, is where the money is at. It has been shown to reduce anhedonia in depression at low doses, and in those low doses also increases glutamine/ergic transmission. In combination with lamotragine, I think it could be an even more affective tool. I was on 600mg of lithium, and 400mg of lamotragine, and I found an amazing balance of moods. But, I had to lower my lithium as I do have kidney damage, plus type 2 diabetes, and almost had to go on dialysis because of the lithium load. It was very close, and my father died of kidney disease, and I watched him wither on dialysis till the very end. I absolutely do not want to die that way. And yes, I know all about the low dose at bedtime method of lithium use.
Jay
Posted by SLS on February 5, 2023, at 11:05:42
In reply to Re: Lithium in suicide prevention -- short review » SLS, posted by Jay2112 on February 4, 2023, at 19:26:10
Hi, Jay.
> > When I took lithium at high dosages, I felt passive. I wonder if passivity is a component of its anti-suicide properties.> ...my father died of kidney disease, and I watched him wither on dialysis till the very end. I absolutely do not want to die that way.
I'm sad to hear that.Harvard used 300-600 mg/day of lithium in their investigations using it as an adjunct to Prozac. 450 mg/day did significantly better than 600 mg/day. My dosage window of lithium is very narrow.
150 mg/day = No response
300 mg/day = Remission
450 mg/day = RelapseI get the feelings that 600 mg/day is really too high to be effective when using a low-dosage strategy. As an experiment, you could decrease your lithium dosage to 450 mg/day for no longer than 2 weeks. For many people, an improvement emerges in less than a week. If you feel worse, then I guess 600 mg/day or higher will work best for you. The idea is, of course, to find the minimum effective dosage in order to prevent further kidney damage and spare the thyroid. If, however, you feel no worse at 450 mg/day, but have not improved adequately after 1-2 weeks, then reduce the dosage to 300 mg/day and see what happens. If you relapse along the way, you will have found your lowest effective dosage. It equals the dosage of one step above the dosage that allowed you to relapse.
Your dosage of lamotrigine (Lamictal) is unusually high when treating mood disorders. My impression over the years has been that most people respond to 200 mg/day. A minority need to raise the doage to 300 mg/day. Lamotrigine is different from lithium in that it doesn't lose its effectiveness when you go higher than the lowest effective dosage. The only repercussions that I can think of is that you might experience the onset of cognitive and memory impairments or their exacerbation. However, I don't think you can judge so early in treatment as to whether or not these side-effects will resolve after being on the drug for a few months. They could also be start-up side effects that disappear rather quickly. With me, they emerged at 100 mg/day, but mitigated over time at 300 mg/day. The memory and cognitive impairments that I experienced early in treatment have disappeared entirely. Currently, lamotrigine is a staple for treating bipolar depression. I haven't looked for a study that compares the efficacy of lamotrigine in treating unipolar depression versus bipolar depression.
If you take a generic lamotrigine, which company's product are you currently using?
Which company have you found to be best?
Teva pharmaceuticals makes a version of lamotrigine that they call "Lamotrigine XR". Do you know anything about it?
Thanks.
- Scott
Posted by Hugh on February 6, 2023, at 11:38:53
In reply to Lithium in suicide prevention -- short review, posted by undopaminergic on January 31, 2023, at 10:52:44
This appeared in Time magazine in 1971:
By legend Texans are a grandiose breed with more than the natural share of megalomaniacs. But University of Texas Biochemist Earl B. Dawson thinks that he detects an uncommon pocket of psychological adjustment around El Paso. The reason, says Dawson, lies in the deep wells from which the city draws its water supply.
According to Dawson's studies of urine samples from 3,000 Texans, El Paso's water is heavily laced with lithium, a tranquilizing chemical widely used in the treatment of manic depression and other psychiatric disorders. He notes that Dallas, which has low lithium levels because it draws its water from surface supplies, has "about seven times more admissions to state mental hospitals than El Paso." But state mental health officials point out that the mental hospital closest to Dallas is 35 miles from the city, while the one nearest El Paso is 350 miles away--and the long distance could affect admission figures.
But FBI statistics show that while Dallas had 5,970 known crimes per 100,000 population last year, El Paso had 2,889 per 100,000. Dallas (pop. 844,000) had 242 murders, El Paso (pop. 323,000) only 13. Dr. Frederick Goodwin, an expert on lithium studies for the National Institute of Mental Health, doubts that "lithium has these magical properties in the population." Others are not so sure. If lithium does have anything to do with the relative peace in El Paso, what would it do for other cities like New York and Chicago?
This appeared in The New York Times in 2014:
Although it seems strange that the microscopic amounts of lithium found in groundwater could have any substantial medical impact, the more scientists look for such effects, the more they seem to discover. Evidence is slowly accumulating that relatively tiny doses of lithium can have beneficial effects. They appear to decrease suicide rates significantly and may even promote brain health and improve mood.
Yet despite the studies demonstrating the benefits of relatively high natural lithium levels present in the drinking water of certain communities, few seem to be aware of its potential. Intermittently, stories appear in the scientific journals and media, but they seem to have little traction in the medical community or with the general public.
When I recently attended a psychopharmacology course in which these lithium studies were reviewed, virtually none of the psychiatrists present had been aware of them.
Researchers began to ask whether low levels of lithium might correlate with poor behavioral outcomes in humans. In 1990, a study was published looking at 27 Texas counties with a variety of lithium levels in their water. 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.
Almost 20 years later, a Japanese study that looked at 18 municipalities with more than a million inhabitants over a five-year period confirmed the earlier study's finding: Suicide rates were inversely correlated with the lithium content in the local water supply.
More recently, there have been corroborating studies in Greece and Austria.
Trying to make sense of their results, the authors of the Japanese study speculated that lithium exposure, even in these tiny amounts, might actually be neuroprotective or even enhance the growth of neurons. Other studies have supported their speculation; lithium appears to promote the health, growth and resilience of neurons, reducing stress-induced damage.
Dr. Nassir Ghaemi, a professor of psychiatry at Tufts University School of Medicine and one of the most active and informed proponents of lithium in the medical community, notes: "Lithium is, by far, the most proven drug to keep neurons alive, in animals and in humans, consistently and with many replicated studies." And, he added, "If lithium prevents dementia, then we may have overlooked a very simple means of preventing a major public health problem."
When the data from the Japanese study was reanalyzed in a second publication, the authors concluded that those people with higher levels of lithium in their water supply had lower levels of "all-cause mortality." Why have these findings been so little discussed in the medical, psychiatric and public health communities?
Some scientists have, in fact, proposed that lithium be recognized as an essential trace element nutrient. Who knows what the impact on our society would be if micro-dose lithium were again part of our standard nutritional fare? What if it were added back to soft drinks or popular vitamin brands or even put into the water supply? The research to date strongly suggests that suicide levels would be reduced, and even perhaps other violent acts. And maybe the dementia rate would decline. We don't know because the research hasn't been done.
For the public health issue of suicide prevention alone, it seems imperative that such studies be conducted. In 2011, suicide was the 10th leading cause of death in the United States. Research on a simple element like lithium that has been around as a medication for over half a century and as a drink for millenniums may not seem like a high priority, but it should be.
Posted by SLS on February 6, 2023, at 19:47:23
In reply to Re: Lithium in suicide prevention -- short review, posted by Hugh on February 6, 2023, at 11:38:53
Another perspective.
https://pubmed.ncbi.nlm.nih.gov/28604590/
I hope scientists establish a minimum concentration of lithium in drinking water necessary to produce positive results in both Alzheimer's Disease / Dementia and suicide prevention.I read one article that suggested all of the drinking water studies regarding lithium and the reduction in Alzheimer's Disease were wrong, despite their ubiquity. I encountered only one such contradictory citation, though.
The results from studies of lithium in drinking water and suicide rate are contradictory. Interestingly, the ability of trace amounts of lithium to reduce suicide rates applies to males, but not for females.
- Scott
This is the end of the thread.
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