MODERN RESEARCH ON THE CHEMICAL EFFECT ON THE BRAIN

MODERN RESEARCH INTO THE AFFECT ON BEHAVIOR

Most readers may want to skip this section as it delineates what you probably already know. Before 1949, lithium carbonate, though common in spring drinking water, was rarely used in pill or powder form except as a medical antacid because it adsorbed large amounts of stomach acid. For over one hundred years the popular forms of lithium used for public consumables was lithium oxide (lithia) and lithium chloride. This section is not meant to be a medical guide but more of a translation to the lay person, non-user, as to what the current mono-use, mono-mindset of the medical field is towards the use of lithium carbonate.

B. MOOD DISORDERS Mania, Depression, Bipolar (both). One of the two key problems in speaking of Lithium is that those who have an idea of the meaning of the word, assume you are talking about a bipolar or manic- depressive related item. Most people, 70-80%, don’t know what lithium is. The few that are familiar with the term associate it by having heard it mentioned related to treating manic-depression and so far do not associate it with batteries, which is probably where they most often see the written word.

Definitions

Depression “You will become low-spirited, sad, withdrawn, and miserable. You will have difficulties sleeping, concentrating, eating, and will often lose interest and energy.” [31]

“Depression is a condition where there is an exagerated feeling of sadness, melancholy, extreme fatigue, hypersomnia, dejection and worthlessness.” [16]

Mania You will feel elated, over-confident, full of energy, “On top of the world”. You may sleep little, talk very fast, and do out of character irresponsible things (including promiscuity). [31]

“Mania is a condition where there is extreme excitation, excessive elation, agitation, over talkativeness, flight of ideas, fleeting attention, racing thoughts, obsession with sex, and sometimes violent, destructive, or self-destructive behavior.” [16]

Manic Depression (Biploar) “Depression and Mania are the two opposite poles of mood.” [16] Is the swinging back and forth between the two states (poles). Lithium prevents the excessive swings. [31] Bipolar can include mania, hypomania, grandiosity, flight of ideas, rapid & incoherent speech, promiscuity, sleep disturbance, self mutilation, violent, destructive, or self-destructive behavior. Whether lithium is the treatment of the symptoms caused by somthing else or the symptoms are the bodies way of reacting to a deficiency of lithium. If so, are all people deficient in lithium to some degree bipolar?

“It is estimated that 5% (50/1000) of the adult population in the US is suffering from clinically significant mood disorders. Yet only 2.0% (1/1000) are under treatment.” [16] [42]

“A little lithium may be just what the doctor ordered” “Millions of people around the world swallow it in various doses. It keeps them from binges of promiscuity, psychotic rages, out of control spending, and suicide [2].

TREATMENT

PRESCRIPTION

Lithium is now commonly used in the treatment of depressive and Bipolar affective disorders. Lithium is readily absorbed through the gastrointestinal tract but not the skin. [28] Lithium is not metabolized (formed into another chemical compound). [28] Lithium is available only for oral administration (in America read pill not liquid) and is almost completely absorbed in the GI tract with peak levels 2-4 hours postingestion [14]. The therapeutic dose is 300-2700 mg per day with desired serum levels of 0.7-1.2 nEq/liter. The plasma elimination half-life of a single dose (time it takes to excrete one half of the amount ingested) is 12- 27 hours and increases to 36 hours in the elderly [14].

Prescription: Lithium Carbonate Trade names: Eskalith, Lithane, Lithotab, Lithonate, Lithotabs. Lithium is mainly available as lithium carbonate (300 mg tablets, Licab by Torrent and Lithocarb by Merck) and Lithium Citrate syrup. Lithium Citrate is more commonly used in Europe than the United States [16].

Adsorption can be much slower in massive overdose or with sustained release preparations [14].

Sodium Bicarbonate (baking soda, alka-seltzer, bromo-seltzer) counteracts lithium [17]. Sodium causes the excretion of lithium and people on salt free diets should not be administered lithium. Sodium can be consumed in the form of table salt, baking soda (in foods) and certain antacids and excess intake may counteract the prescribed lithium by causing the body to excrete it too fast.

With readsorption, the effect of lithium is increased and toxity more likely if hyponatremic (sodium depleted) or volume depleted (by dehydration or diuretics) or (renal impairment). [14]

Husseini K Manji, of Wayne State University in Detroit, noted “the delay in protection (about a week) is particularly striking since the hallmark of lithium therapy is that it can take a week or longer to benefit people (near toxic doses build in effect for days after ingestion) [7] The dissolvability of lithium carbonate can be widely affected by the level of stomach acid, the amount of liquid (see the solubility index), and coating affect of certain ingested foods & oils. I found no tests of specific doses of lithium oxide or hydroxide, lithium chloride, lithium orotate, lithium citrate to a standard dose of lithium carbonate and resulting blood levels of lithium.

The second key problem in talking about “Lithium” is that people “in the know” presume you are talking about “lithium carbonate”. Despite the use of explicit compound names, once they only hear the “lithium” part, they think lithium carbonate, the only term they know. The collorary of this statement is their insistence on using the term “Lithium” when they mean “lithium carbonate”. The features of lithium carbonate, ie, lithium carbonate upsets the stomach, are assumed to be a feature of any compound containing lithium. [3] Neither lithium chloride (as in Westsal or commercially lithiated beverages) or Lithium Oxide, as in White Rock Lithia have ever been reported as “disturbing the stomach” and in fact the opposite was true. Another is that Lithium dissolves slowly building in strength over 5-30 days. This is true of lithium carbonate and in fact causes problems when to blood level of lithium doesn’t show an increase after a week or two and the dosage is increased. In fact, liquid forms of ionized lithium go into the blood stream within minutes (beverages or syrups) or 6 hours to 3 days for highly dissolvable solid form like lithium chloride, lithium orotate, or lithium citrate.

Pharmacy Lithium Carbonate prescribed for Bi-Polar disorder and other related anxiety, depression, PMS and anger / aggression symptoms. Also used for eating disorders and thyroid problems. The initial dose is usually 1200 mg per day. The therapeutic dose is 300-2700 mg (0.3-2.7 grams) per day [14].

Most side effects from the use of Lithium Carbonate are infrequent and more likely to occur during the introductory adjustment period. Side effects include fatigue, weakness, fine tremor of the hands, nausea and vomiting, thirst and polyuria. Polyuria is increased urine output [5]

The main problem with lithium is that when patients feel better, they stop their medicine and mania, hypomania, grandiosity, flight of ideas, rapid & incoherent speech, and sleep disturbance return [29]. This is analogous to people who stop taking an antibiotic when they feel better but before the course of medication is completed, the infection can return, now immune to the antibiotic. Patients terminating lithium abrupty, who experience a return of symptons, may find that lithium no longer relieves their synptoms.

Long term usage side effects are rare but may include:

Hypothroidism Long term exposure might lead to hypothyroidism. [18] Less commonly but particularly in women, lithium may make the thyroid gland less active than usual. [27] Low doses of synthetic thyroid are used to supplement the lithium carbonate treatment.

The treatment of patients with Lithium compounds (currently LiCl) is known to produce or increase hypothyroidism in some patients. This is why lithium carbonate is used to treeat hyperthroidism.

A TSH (?) of 4.0 is criminal and new medical reports show that at TSH of about 1.0 (preferable is 0.3-0.9) is better. If you are on Lithium, check with Mary Shomon at www.keen.com.

Water Intake Sensible precaution when taking lithium … Drink plenty of non- alcoholic fluids. [27] Why not drink mineral water containing lithium? The reason for this recommendation is the low solubility of lithium carbonate. Since only a small amount of lithium carbonate can be dissolved in a liter of body fluids, it takes an increased amount of fluid to completely dissolve the daily dose of medication. Remember the solubility of of lithium compounds is calculated on the use of distilled water and not fluids with high TDSs as found in the stomach after a meal and the intestines which may be closer to a solid then a liquid.

Solubility Lithium Carbonate and Lithium Citrate, the two forms of prescribed lithium, are only slightly soluble in water and poorly absorbed by the cells [23]. Because of its superior bioavailability (it was not compared to highly soluble lithium chloride), lower doses of lithium orotate may be used to obtain theraputic brain lithium concentrations.

[23](Kling, Manowitz, & Pollack, “Rat Brain and Serum Lithium Concentrations after Acute Injections of Lithium Carbonate and Orotate”, Journal Pharmacy Pharmacol, 1978, June 30(6): 368-70. [23]

Lithium Solubility Table in Water [28] Chloride 454.0 g/L Hydroxide 223.0 g/L Oxide 66.7 g/L Carbonate 13.3 g/L

This table might explain White Rocks switch from Oxide to Chloride. The lithium compound was dissolved in water then filtered to remove the undissolved residual. Chloride would be 6.8 times the solubility of oxide and 34.1 times that of carbonate. One wonders how lithium carbonate would ever be selected as a medication to be taken orally over lithium chloride except that at the time Cade report his findings on lithium carbonate … everyone knew from the recently published JAMA article that lithium chloride is a poison. No testing then or now. No investigation of its historical use in food, water and beverages both frequency and dosage.

Excessive Water Intake According to Dr David Marples of the University of Leeds in Leeds, England, Lithium takers may drink more and in 20% of heavy dose takers excess urinary output may become a problem called polyurea. [42]

Vitamin B-12 Loss Lithium is important in Vitamin B12 transport. [24] Long term lithium supplementation first elevates Vitamin B12 levels and then causes it to drop so theraputic lithium doses should be supported with Vitamin B12 [25]

Lithium Orotate Lithium Orotate is a highly bioavailable form of lithium that is available as an over the counter dietary supplement. (Dean & English, “Lithium Orotate: The unique, Safe Mineral with Multiple Uses, Vitamin Research News, July, 1999 The standard orotate dietary supplements provide 5 mg lithium, or 1-2% of the doose provided by prescription forms of lithium. [23]

Lithium Orotate is a safe nutritional supplement that may help prevent Alzheimer’s disease and alcoholism. [23]

www.nubrain-store.com/lithiumorotate Lithium Orotate [7] * * *

We know from historical records that dissolved lithium oxide in the form of lithia(ted) water, with the highest dosage being in White Rock Lithia, does not upset the stomach, one of the most common complaints of lithium carbonate. We know from the at least 1,000 varieties of lithiated (lithium chloride) beverages in America alone, including White Rock lithiated water after 1901 that lithium chloride does not upset the stomach. The use of lithium chloride by Dr Cleaveland and Westsal, showed people liked the taste, it did not upset the stomach, and in doses of 1-3 grams per day, without sodium intake, and with renal disease affecting output, the blood level of lithium increased to toxic levels in 12 hours to 3 days. It would seem obvious just from historical records alone that the least likely chemical to use to get lithium in the body would be lithium carbonate, bad tasting, stomach upsetting, and unregulated dosage delivery of 5-30 days. This alone can mislead doctors to accidently raise blood lithium levels to a toxic level.

TOXIC

It is estimated there are 10,000 toxic exposures (about 10 % are in children under 19) per year with 2,000 moderate to severe outcomes in the US. About 10% are in children under 19 years. [14] Most acute poisonings are a) accidental or b) deliberate overdose ingestions by patients or c) ingestions by untreated patients. Extreme lithium levels may slow half life to 60 hours.

(insert symptoms www.emedicine.com) [14] Lithium Toxicity, J Linakis, MD Associate Professor of Pediatrics, Dept of Emergency Medicine, Hasbro Children’s Hospital, Providence RI. [14]

The toxicity of lithium compounds is a function of their solubility in water (ionization). [18] See chart ….

Lithium tends to take longer to work on adolescents than for adults. It may take several months and doctors who don’t see a quicker reaction may increase the dose producing a mild chronic poisoning. [17]

“Acute Posioning” – Voluntary or accidental ingestion in a previously untreated patient. [14]

“Acute on Chronic” – Voluntary or accidental ingestion in a patient currently using lithium. [14]

“Chronic (Theraputic) Poisoning” – Progressive lithium toxicity in a patient on lithium therapy (too much lithium, to little sodium, renal insufficiency, or use of drugs that increase lithium toxicity at therapeutic levels). [14]

[16] “Lithium Toxicity – A Review” Dr Anil Aggrawal, Dept of Forensic Medicine, Maulana Azad Medical College, New Delhi, India.

Lithium Carbonate Tablets 300mg

tablets per day Mg per day Grams Therapeutic 3-5 900-1500 0.9-1.5 Mild Toxicity 6-10 1800-3000 1.8-3.0 Serious Toxicity 9-15 2700-4500 2.7-4.5 Life Threating 20 6000 6.0 Clinical Management of Poisoning and Drug Overdose, 1990, Saunders Co., pg 658.

450 mg of lithium carbonate (may) supply 84.5 mg of elemental lithium (depending on digestion). [25]

Toxic effects usually associated with excesive dosage, renal insufficiency, or sodium deficiency include stupor, coma, muscular rigidity, marked tremor, and/or epileptic seizure.

Accidential poisoning by lithium tablets is not very common, but can occur. A misguided attempt to take several tablets together in a vain attempt to “get well quick” may cause accidental poisoning. [16]

Cases of suicide by lithium are on record. A doctor should assure that the stock of lithium tablets is never with the patient, who can take the tablets together in an attempt to kill himself. [16]

[4] www.oso.com/shared/health/adam/ency Illustrated Health Encyclopedia. Lithium overdose. Attempted suicide by lithium overdose. Emesis, induce vomiting. find patients age, weight, condition, name of product, strength, time ingested, amount, doctor. [4]

Lithium has never been used for homicidal purposes. Available literature does not show a single case of homicide by lithium. [16]

The risk of Lithium toxicity is directly related to sodium depletion. [26] (lead for rating of toxity)

To date, lithium toxcity has not been reported associated with the consumption of foods rich in lithium or from the consumption of water from mineral rich springs or artesian wells. [26]

Toxicity Profiles, Toxicity Summary for Lithium, Dennis Opresko, PhD, Health Sciences Research Division, (RAIS: Risk Assessment Information System) Oak Ridge, Tennessee. [28]

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