Should we all take a bit of lithium? asks a provocative opinion piece in last Sunday's NY Times. The article's author, Anna Fels, is a psychiatrist and a faculty member at Weil Cornell Medical College. Her pieces, which have graced the Times for a number of years, have that rare "why hadn't I thought of that before?" quality.
Certainly, that has been her effect on me.
We know that for years, lithium was the default pharmaceutical treatment for bipolar disorder. Even today, this common salt, with no patent protection, holds its own against its heavily bankrolled competition.
But does lithium have other potential mental health uses? Good question ...
Drinking the water ...
Dr Fels cites a number of studies going back to 1990 that show an inverse correlation between the amount of lithium naturally occurring in local drinking water and rates of suicide, homicide, and rape.
A recent review of 11 studies found that higher lithium levels corresponded to "beneficial clinical, behavioral, legal and medical outcomes."
Another study suggests that lithium may prevent dementia.
Dr Fels points out that the amounts in question equate at most to about a thousandth of the daily minimum dose prescribed for bipolar patients.
We need to note that finding correlations is not the same as proving cause and effect. Nevertheless, evidence is emerging that lithium - in addition to leveling out the highs and lows of bipolar - may 1) promote overall mental well-being, 2) prevent suicides, 3) act in a neuroprotective capacity.
For the general public, this might involve drinking fortified water (out of bottles, one hopes, not from a specially treated public water supply). For those of us already taking lithium for bipolar, this may offer incentive to remain on the medication.
My initiation into the issue came in the early 2000s when I talked to Husseini Manji, then at the NIMH, now a vice president at J&J. Dr Manji found that lithium increased brain cell growth in rats. Brain scans on humans suggested similar effects.
As Dr Manji explained to me, lithium may protect the neuron against the toxic effects of stress. What may start out as a fight-or-flight reaction typically ends up with the neuron under assault from glucocorticoids and glutamate. The molecular chain reactions inside the neuron - those responsible for cell maintenance and performance - sputter and stall, taking the neuron off-line.
Blow out enough neurons, and entire neural networks are compromised. Signaling weakens. The brain can't do its job.
Dr Manji stressed to me that while bipolar may not be the type of neurodegenerative illness we associate with dementia, there certainly is an "atrophic" element to it, involving the risk of cellular damage.
This view harmonizes with the earlier findings of Michael Meany of McGill University, who found that rats exposed to stress developed more glucocorticoid receptors in the brain's hippocampus, associated with memory and emotions.
This takes us into the field of neurogenesis and neuroplasticity, pioneered in the late nineties by Fred Gage of the Salk Institute and Ron Duman at Yale. The combined effects of their research found that the brain can produce new neurons in the hippocampus and that these neurons can be integrated into existing neural circuits.
The implications of these and other findings are truly mind-boggling, namely: With a little help, damaged neural systems have the capacity to mend. At the very least, we can think about protecting our neurons against future possible damage.
Various lab experiments indicate that exercise can have this effect, as can nurturing environments, as can antidepressants, as can lithium. We can probably make a case for healthy diet and nutrients.
A brief history of lithium ...
Lthium's putative beneficial effects were observed in the nineteenth century, when people visited lithium spas and drank the bottled water.
These observations led to research in the early twentieth century, which in turn led to John Cade's 1949 breakthrough in using the element to treat bipolar. Clinical trials conducted by the Mogens Schou in the 50s and 60s paved the way for its acceptance in Europe and the US.
In the context of bipolar, we are talking of doses just short of toxic. Patients on high doses frequently struggle with lethargy and impaired cognitive function. Kay Jamison, in her memoir, An Unquiet Mind, reports not being able to engage in serious reading for two years. Yet, on lower doses, it proved to be her miracle drug.
In the context of neuroprotection, on the other hand, we are talking about doses at levels found in nature, a thousandth of what a doctor would prescribe for treating bipolar, maybe a bit higher. In my interview with Dr Manji, he laid great stress on micro-doses. Just to be clear: He was not advocating its use - he was simply making the case for further research.
Take home message ...
Our view of treating mental illness as something that is broken that needs to be fixed tends to blind us to the fact that even healthy brains require tender loving care. Feeding, watering, rest, diet, exercise - the list goes on and on. In this context, we are talking about the possibility - and I emphasize possibility - of lithium at natural levels as part of our normal brain maintenance.
Maybe someday, lithium will be in the bottled water you drink while going out for a walk in the sunshine. In the meantime, drink the water you have, take that walk, enjoy the sunshine.