Bipolar Disorder Medication Spotlight: Lithium Orotate
A number of people have written about their experiences with lithium orotate as an alternative to pharmaceutical lithium (lithium carbonate or lithium citrate). I wanted to know more about it, so I reviewed the research. The bottom line is that we know very little about lithium orotate – the data is scant and old and tells us very little about the safety or effectiveness of lithium orotate as a substitute for lithium carbonate, the standard formulation.
Lithium orotate is an over-the-counter (OTC) product that, when taken, releases the lithium ion into the blood stream and brain. This is exactly the same result as when someone takes lithium that has been prescribed by a physician. And this is what reduces symptoms of bipolar disorder, so the positive effect of lithium orotate is exactly the same as prescription lithium.
The touted advantage to the orotate formulation is that it is more “bioavailable,” meaning that it creates higher blood and brain levels from smaller doses than regular lithium. In theory, this could reduce side effects of lithium by requiring lower doses to get the same effect. However there have been no human studies that have shown that it is more bioavailable or that it causes fewer side effects.
Only three studies look at any part of the bioavailability concept scientifically – they were all done in the 1970’s and they were all done on rats:
- One study showed no difference in the availability and clearance (how fast the medicine leaves the body) between the different formulations of lithium (Smith et al. 1976).
- Another study showed a significant difference between lithium orotate and lithium carbonate (Kling et al. 1978).
- The most recent study, done in 1979, confirmed the higher blood and brain levels, but found that it was related to slower clearance by the kidneys rather than any difference in its “bioavailability” to start with (Smith et al. 1979). The conclusion of this last study was that it would be inadvisable to recommend using lithium orotate in humans.
One human study was done in 1986 but this looked at the treatment of alcoholism. No human studies have looked at whether or not lithium orotate is effective in treating bipolar disorder. A recent article (Pauze et al. 2007) described lithium toxicity due to an intentional overdose of lithium orotate.
My assessment is that lithium orotate probably works for bipolar disorder – it releases lithium into the brain and body and we know that the lithium ion is effective in treating bipolar disorder for many people. The problems are that I have no research to support that conclusion and what little research I do have about this compound is conflicting and done only on rats.
There is a suggestion that lithium orotate could be successfully used at lower doses than regular lithium, but there are also very serious concerns about kidney function and high blood levels of lithium using this product. Just like regular lithium, there is little difference between a therapeutic blood level and a toxic blood level of the lithium ion, and the toxic level can cause grave illness and even death. We have no well designed studies in humans looking at any of these questions.
Warning: I would strongly recommend against self treating with lithium orotate. Like all conditions, we sometimes use things that we don’t have a lot of evidence for in extreme situations, and I imagine there could be rare circumstances in which, together with a prescriber, someone might use this product instead of lithium carbonate, but people who were to choose this approach would still need to be followed for blood levels and any evidence of lithium toxicity.
Keep in mind as well that lithium orotate is marketed as a supplement, not a drug, so it is not regulated by the FDA – as a result, it is hard to know which products are even reputable or provide what they say they do. If you are interested in lithium orotate, talk about it with your prescriber and consider it carefully – remembering that, in fact, it is actually a psychoactive medication and it needs to be managed carefully.
Kling MA, Manowitz P, Pollack IW. “Rat brain and serum lithium concentrations after acute injections of lithium carbonate and orotate.” J Pharm Pharmacol. 1978 Jun;30 (6): 368-70
Pauze DK, Brooks DE (June 2007) “Lithium toxicity from an Internet dietary supplement.” J. Med Toxicol 3 (2): 61-2
Sartori HE. “Lithium orotate in the treatment of alcoholism and related conditions.” 1986 Mar-Apr; 3 (2): 97-100
Smith DF, Schou M. “Kidney function and lithium concentrations for rats given an injection of lithium orotate or lithium carbonate.” J Pharm Pharmacol. 1979 Mar; 31 (3): 161-3
Smith DF (April 1976) “Lithium orotate, carbonate and chloride; pharmacokinetics, polyuria in rats.” Br J Pharmacol. 56 (4): 399-402
Fink, C. (2008). Bipolar Disorder Medication Spotlight: Lithium Orotate. Psych Central. Retrieved on October 10, 2015, from http://blogs.psychcentral.com/bipolar/2008/09/bipolar-disorder-medication-spotlight-lithium-orotate/