Lithium Orotate Dosage

This post is about the dose of lithium orotate I take, and how I take it.  It's not about what dose you should take.  I am not a doctor, and can not make any guess on how much, if any, would help you.

I have been taking lithium orotate for many years now to treat my bipolar disorder.  Currently, I take 3 pills of the Vitamin Research brand of Lithium Orotate. Each pill contains 4.8mg of elemental lithium.  I take 2 in the morning and 1 at night.  I don't know if a split dose is necessary - it's just how I've always done it.

If I miss a dose, I usually don't notice anything.  I only start getting increased symptoms if I go without taking it for a couple of days.  So I think it has a fairly long half-life.  But that's just a guess.

I have previously taken 4 pills a day, but now I can manage on just 3.  Some of this might have to do with the fact that I've lost some weight.  There are many medications where the required dose depends on body weight, and it's possible that lithium orotate is one such medicine, but that's also just speculation.

Lots of medicines require regular dosing before the full effect is felt.  If this holds true for lithium orotate, the full effect might not be felt until taking it for several days to a week.   I try to stick to a regular schedule.  I use a pill box to help me to remember to take it.  It also prevents accidental double dosing.  I have in the past taken the Advanced Research brand and the Doctor's Best brand (now discontinued).  I've noticed no difference in effectiveness and usually buy whatever brand is cheapest.  Both the Advanced Research brand the Vitamin Research brands have some quality control issues.  Occasionally, the Advanced Research brand had broken tablets and the Vitamin Research brand has crushed capsules.  Not a huge issue, but something I would be amiss to not mention.

The dosing for lithium orotate can be confusing because there are two numbers that are usually listed on the bottle. First, there is a higher number, like 120-130mg, which is the amount of lithium orotate in each capsule or tablet.  Then, there is a lower number, usually around 5mg, and that's the actual amount of lithium.  The orotate molecule that the lithium is attached to is heavier than the lithium, and that's why you only get about 5mg of lithium from a 125 mg pill.  

Does Lithium Orotate work for Bipolar Disorder?

It continues to puzzle me as to why doctors don't prescribe Lithium Orotate

Sure, it's not like lithium carbonate.  It doesn't cause any sustained increase in serum level.  It also is not a prescription.

However, it works, and not just for me.  If you read the reviews, you'll see that many people find it helpful for mood swings, anxiety, and depression.

How does it work for me? Well, it makes me less moody. It also prevents mania. I experience the same therapeutic effect that I had from lithium carbonate, minus the side effect of hand tremor.

I recently tried to increase the dose from 4 pills a day to 5.  It made me too thirsty, so I reduced it back to 4.

This thirst is the first definitive side effect I've experienced from it.  What's interesting about the thirst side effect, is that it didn't happen immediately after taking the pills, but rather much later in the day.  So it seems that even though the blood level is not measurable, there is some long lasting effect from the lithium orotate.

Anyway, I'm not advocating Lithium Orotate, but just wondering how come such a seemingly effective medication is ignored by mainstream psychiatry.

Lithium Orotate Blood Level Test

Good news here!

After taking lithium orotate for about 6 years, I finally got a lithium blood level test done.  I got health insurance and during my physical I told my doctor about taking lithium orotate and asked for a lithium test and a kidneys function test. She thought that was a good idea and also did a thyroid (TSH) test.  My doctor didn't know that this form of lithium was available over the counter as a supplement.

So, my results are in, and my lithium level is <0 .1, with the standard reference range between  0.6-1.2mmol.  I take 4 pills of the Doctor's Best Lithium Ororate, in a split dose (2 in the morning, 2 at night), which comes out to 20mg of elemental lithium.

(Update: Doctor's Best brand has been discontinued, but I've found both the NCI Advanced Research brand the the Vitamin Research brands to be equally effective.)

This low result is pretty much what I expected from doing research online. For some reason, lithium orotate does not stay in the blood, but rather goes into the cells.  This inability to read a lithium level makes some doctors think it doesn't work, but from my personal experience, I can sure tell you it does work for me.

In fact, it has fewer side effects..  The prescription form, lithium carbonate, causes a hand tremor that lithium orotate doesn't cause.  Lithium orotate might have the same thirst side effect - I do get thirsty often and do drink a lot of water - but can't really say for sure whether that's from the lithium orotate or whether that's just me.  It might also cause weight gain - although my weight gain is just as likely from genetics or eating habits or normal aging. So I'm not completely sure that the lithium orotate has any side effects.

The other blood tests I had done all came out normal. Normal metabolic panel, normal O TSH Reflex FT4, normal O CBC with Diff.  So it appears that the lithium is not harming my kidneys, liver, or thyroid.

By the way, the blood test was done about 3 hours after taking my morning lithium dose.  And I've been on the same dose for years.  I may consider raising it.. sometimes I feel that I could use a bit more therapeutic effect.  But not having many scientific studies, it's hard to know what the best dose is.

For more information about the importance of the lithium blood level test, check out this excellent explanation by Dr Phelps: Please explain the therapeutic range level of lithium and it's significance for  management of the illness.    (Dr. Phelps also has an excellent website on Bipolar II: PsychEducation.org)

Stop lithium to see if I really am still crazy

That's a crazy thought.

I'm sure anyone who's on psych meds has had it.... Maybe if I stop taking them I'll be able to handle it.. Maybe I'll have more inspiration.. Maybe I'm not sick anymore.. Do I really need them?

Today, as I was refilling my pill box, I was thinking about which pills I need the most, and that turned into my wondering what would happen if I did lower the lithium.....

But I've been there, done that.  The lithium makes my life so much easier.  So much better.  Less arguements, less turmoil, less crisis.

And so, I do stockpile my lithium, and I rarely miss a dose.  With it, my life is better.....

Lithium Flatness and Dosage

In a previous blog post, I hypothesized that taking too much lithium is the cause for the flatness that some people experience.

After reading a lot more, I have to correct myself.  Apparently lithium just makes some people feel flat. Period.  It doesn't happen to me.  But it does happen to some people.  It's a side effect that you might or might not have. And it probably has more to do with individual differences than dosage.

I'm sorry if lithium makes you feel flat. I hope that you will find a medicine that does work perfectly - removing the mania and depression but allowing for life's normal ups and downs.  That's how it should be.

Successfully Switched Brands of Lithium Orotate

When I first started buying lithium orotate, the only generic brand of Lithium Orotate I could find was the Advanced Research brand.  Now the iherb website offers two other brands: Doctor's Best and Ortho Molecular Products.

I've bought other supplements by Doctor's Best in the past, and I've been very happy with their quality.

However, it took me two tries to make the switch over to Doctor's Best from the Advanced Research brand.  I don't know why, but I felt that it took about two to three days for the new brand to work.  So the first time I gave up, thinking that it didn't work. But now finally I've made the switch and I've been taking the Doctor's Best Lithium Orotate for about a week and a half.  I'm taking 4 pills a day, which is higher than the 3.5 pills that I was recently taking.  Also the Doctor's Best brand has 5mg of elemental Lithium per pill, whereas the Advanced Research brand was only 4.8mg per pill. So I am getting a higher dose but I feel great!  My moods have been pretty smooth, my concentrate excellent, and my anxiety way less. The holidays are generally a stressful time of the year for me, so I plan to stay on this dosage for at least the next several months.

Unfortunately, I find the lithium orotate pills very hard to cut, and that's especially true with the Doctor's Best brand. My pill cutter tends to crush them instead of cutting them.

The Doctor's Best lithium orotate is in tablet form, just like the Advanced Research brand. However, the Doctor's Best tablets are harder and have a shiny coat to them.  My main problem with the Advanced Research brand is that the tablets are so soft that they easily break.  Often there are a handful of broken pills in the bottle. Also, in my last bottle, there were several pills that were the wrong shape (too thick) which made me really question the quality control!  I didn't take the wrong shaped pills, as there was no way for me to know if they were lithium or not.  This is kind of scary, and why I finally switched over to Doctor's Best brand.

If you are looking to buy lithium orotate, you can use a $5 off coupon on iherb if you are a first time customer.  Just enter the code LIN282 during checkout on the iherb website.

Click here for more information on Lithium Orotate.

Please note that I'm not a doctor and this is only about my personal experience. This is not medical advice.  I highly recommend that you consult with a doctor before starting on any supplement.

Lithium Flatness (loss of creativity, not liking lithium)

A lot of people seem to not like being on lithium (or some other mood stabilizer).  They say that it ruins their creativity, makes them feel flat or emotionless.


I don't have this problem.  And I propose that there are two reasons for this, which need to work together -

1. Take the lowest dose of lithium or other mood stabilizer that is effective.

2. Make lifestyle changes.

If you think of mania or hypomania as being similar to alcoholism, except that the addiction is to "excessive involvement in pleasurable activities that have a high potential for painful consequences," whether it be sex or shopping or drugs or whatever your activity of choice is - then you can see how taking a mood stabilizer alone isn't the whole solution.

You have to change your lifestyle.  That is, your activities. If you are an alcoholic and love going to the bar but then start taking a medicine that makes you not able to drink, then you're not going to like that medicine because when you go to the bar you won't experience the same enjoyment as you used to.  The key of course, is to stop going to the bar.

I propose that you can have creativity and lots of emotions and be taking a mood stabilizer, IF you refocus your life on activities that aren't excessive and that don't have painful consequences.

If you can successfully change your lifestyle, then you may even be able to reduce the mood stabilizer.  Ideally, you want to be taking the mood stabilizer at the lowest amount so that you can still feel a wide dynamic of emotions.

Changing your lifestyle is not easy, and could involve major changes like changing a romantic relationship, changing your friends, changing where you live, changing careers, etc.  This is all stressful stuff that by itself could cause your moods to become worse, which is why you might need to see a therapist and a psychiatrist regularly so you can keep your meds adjusted as you go through these changes.

Also, some of your experiences might be rooted in not just brain chemicals gone awry, but they might be the result of environmental problems like trauma, lack of self confidence, difficult relationships, etc. Things that need to be worked through over time, perhaps in therapy.

So the mood stabilizer is just one part of the equation.  It's a big part, but if you aren't committed to making changes, then the mood stabilizer alone might not work.  The good news is that usually a mood stabilizer changes your thoughts enough that it makes it easier for you to slow down and do some self-examining to see what you want your life to look like.  You just have to embrace the opportunity to ask yourself big questions.

I'll leave it to you to come up with the questions that need to be asked.

--

Footnotes:

1. I'm not a doctor, but from personal experience, I would suggest that you might need a higher dose of lithium or mood stabilizer at first, but that after you have made lifestyle changes and/or sought other treatment like therapy, then the mood stabilizer might be adjusted downward.  However, you have to always be watchful of a dangerous hypomania/mania episode coming on... Best to catch these episodes by watching your THOUGHTS and catching them before your actions take a turn for the worse.

2. Omitted from above, is this:

Going to the bar doesn't have painful consequences for everyone, but it does for alcoholics.

Similarly, whatever activity you became addicted to while hypomanic, you should try to avoid.

This statement might be a bit radical, but avoiding something at first might be a good idea. For example, don't go to the mall if you have trouble with spending too much money.

My Experience with Lithium

What a relief medication can be.

What I know about Lithium Orotate

NOTE:
I am not a doctor or medical professional, and I am not recommending lithium orotate use.
--

Lithium orotate is not well known and not popular among doctors. This is because there are very few scientific studies and most evidence that it works is just anecdotal.

Lithium orotate is a supplement and available without prescription in the United States. There have only been a handful of studies that have been done on it. One study done on rats in 1979 concluded that lithium orotate can cause kidney fuction problems, but the rat was given the same dose of lithium carbonate as lithium orotate. Some people believe that this study is misleading because lithium orotate is effective at lower doses than lithium carbonate.

However, lithium orotate is puzzling because the doses that it is effective at don’t cause the person to reach the therapeutic range for their blood lithium level. When doctors prescribe lithium carbonate, they check the patient’s lithium level, and generally try to maintain a therapeutic blood level of 0.6 – 1.2 mmol/L. However, with lithium orotate, the effective dose often does not cause the person’s blood level to reach that range; in fact, the lithium blood level is so low that it may not be measurable. This is theorized because the lithium goes into the cells rather than stays in the blood. I’m not sure if I understand this, but it seems to cause the lithium to be effective at a lower dose, which also seems to cause less side effects. Lithium can be toxic at blood levels above 1.5 mmol/L, which is also why blood level tests are usually done with lithium carbonate.

In any case, I take 4 pills of Lithium Orotate every day. Each pill is 150mg which contains 4.8 mg of elemental lithium. Some people have found effectiveness with just 1 pill a day. For awhile I was taking 3 a day. I take the Advanced Research brand and it really helps keep my moods stable.  11/12/2011 Update: I take Doctor's Best Lithium Orotate and it continues to work well.
3/20/2015 Update: Doctor's Best brand was discontinued, so I switched to Vitamin Research Brand of Lithium Orotate.

There is one scientific study (Lithium toxicity from an internet dietary supplement) published about a person overdosing on lithium orotate. They took 18 pills and it caused them to have nausea and vomiting but their blood lithium level was only 0.4.

The reason I started taking the lithium orotate was actually my desire to treat myself. It is a risk I take, and not one I advise. But it turned out to a be an affordable solution for me, and an added benefit is no side effect of hand tremor. I took lithium carbonate for awhile, and after about a year, I developed a tremor from it.

I really do like how lithium makes me feel (the mood effects were similar for both lithium carbonate and lithium orotate) because it’s like it just makes me feel normal. When I’m not having to deal with the huge changes in my emotions, then I have more energy to just be myself. I know lithium doesn’t work for everyone, but it’s so good for me that I wish I had found it sooner.

If you want to read anecdotal stories of the lithium orotate, you can read reviews here.

You can read all of the studies availabe (all 7 of them!) at PubMed.gov.


9/7/2012 Update: Results from my lithium blood test.

Thank God for Lithium and Zinc (Medication Update)

I've been taking zinc for about 6 weeks and it has greatly reduced my depression.  I'd say it's been eliminated.  I wrote about zinc for treating depression here.  Let's hope that the zinc keeps working.

I am also taking lithium orotate, which I've been taking for so many years that I've lost track (I'd estimate 4 years).

I still have occasional anxiety and moodiness. I recently lowered my lithium dosage by 1/2 pill (from 4 pills to 3.5) and I do have more symptoms with the lower dosage, but so far it is manageable.  My mood changes are faster and stronger with the lowered dosage, but the trade off is a more dynamic range of feelings.  I think.  It's too early to tell for sure if I'll stick at the lowered dosage or not.  If my stress increases, I may go back up to the 4 pills.

Mood-wise, life is good. Yay!

Lithium Orotate

I used to take Lithium Carbonate, which is the prescription form of lithium, commonly prescribed for Bipolar Disorder.  I took it for over a year, and then I began getting a tremor from it.  

I decided to try Lithium Orotate.  To my surprise, this has been working as well as the Lithium Carbonate.  Except I don't have the tremor side effect.  


I don't notice any side effects with Lithium Orotate.  I do notice problems if I don't take it though, so I take it regularly.  I take it as seriously as I would take a prescribed medication.  


It doesn't make me feel drugged, or less motivated, or less creative, or anything negative. It just makes me feel normal.  Oh, I still occasionally have Bipolar Disorder related mood problems, but certainly not as severe as without the lithium.  Lithium orotate is not a cure, but it comes close.  It reduces many of my symptoms of both mania and depression.


I buy the 120 mg dosage (containing 4.8mg of elemental lithium) by Advanced Research.  For awhile I was only taking 3 pills day, but I now I take 4 pills a day.  I take 2 pills in the morning and 2 in the evening.  It is hard to figure out the correct dosage. I think it has to do with individual differences and perhaps how much you weigh.  Some people only take one or two pills a day.  Best to consult your doctor.


I buy this Lithium Orotate from iherb.com  If you haven't shopped at iherb before, you can get a $5 coupon for your first order by using this referral code: LIN282 

There isn't any scientific proof that Lithium Orotate really works.  Doing some internet searching, I've actually found more links about how it doesn't work than about how it does.  However, there are many positive reviews on iherb.  

By the way, it is also sold under the brand name Serenity. 

Wikipedia does have a useful summary of it here.  It has also been used to treat alcoholism, aggression, and more.