When Lady Gaga recently spoke in an interview about taking lithium while suffering from a "psychotic break", it drew attention to a drug that has long been used in psychiatry but is less widely understood outside it.
Author
- Dipa Kamdar
Senior Lecturer in Pharmacy Practice, Kingston University
Lithium has been used in psychiatric care for more than 70 years , most notably to treat bipolar disorder . Alongside this renewed attention, a recent study has explored whether much lower doses of lithium might help protect the ageing brain - raising questions about whether its effects could extend beyond mental health treatment.
But the science tells a more complicated - and more sobering - story.
Lithium is a naturally occurring chemical element , found in soil, rocks and water. Most people consume tiny amounts of it through drinking water and foods such as vegetables and grains.
In medicine, it is prescribed in the form of lithium carbonate or lithium citrate . At the doses used in treatment, it steadies mood by reducing how often and how severely manic and depressive episodes occur.
It is also one of the few psychiatric medicines shown to reduce the risk of suicide. In the UK, lithium is licensed for bipolar disorder, mania, severe depression and some forms of aggressive or self-harming behaviour.
Despite decades of use, scientists still do not fully understand how lithium works. What is clear is that it acts across multiple systems in the body at once - affecting brain chemicals such as serotonin and dopamine, helping the immune system function more evenly, and helping to regulate the body's internal clock.
It may also slow some of the processes associated with ageing at a cellular level, including protecting the structures at the tips of chromosomes that tend to wear down over time, and supporting the tiny structures inside cells that generate energy. In the brain, these combined effects appear to make nerve cells more resilient to stress and damage.
This has led researchers to explore whether lithium might have a role in diseases where the brain gradually deteriorates, such as Alzheimer's.
An animal study published earlier this year found that when lithium levels in mice were experimentally reduced, the animals developed more of the protein build-ups - amyloid plaques and tau tangles - that are closely associated with Alzheimer's disease, along with faster memory decline. When lithium levels were restored, these changes were prevented. The findings are promising, but they have not yet been confirmed in humans.
Human studies have produced more cautious results. One trial found that a dose of just 300 micrograms of lithium - far below the amounts used in psychiatric treatment - was linked to slower memory loss in people with Alzheimer's disease.
Another two-year trial in older adults in the early stages of memory problems found that low-dose lithium was safe, and that memory fared slightly better in those taking it than in those given a placebo. The difference, however, was too small to be considered reliable by the standards researchers use to judge whether a result is real or down to chance.
A 2023 review also noted that areas with higher levels of lithium in drinking water tend to report lower rates of Alzheimer's disease, although the results varied considerably across studies.
The same review suggested that low-dose lithium might have broader effects beyond the brain, with possible links to heart health, muscle loss, bone thinning and type 2 diabetes. The researchers were clear, though, that the evidence is not yet strong enough to draw firm conclusions.
Lithium as a supplement
So what about taking lithium as a supplement? This is where the picture becomes less clear, and where the risks become more important to consider.
Lithium has what pharmacologists call a "narrow therapeutic window". In plain terms, this means the gap between a dose that helps and a dose that harms is unusually small. People prescribed lithium require regular blood tests to check that levels in the body remain safe, and to keep an eye on kidney and thyroid health. Without medical supervision, none of that monitoring is likely to happen.
Lithium is processed by the kidneys and can build up in the body, particularly in people who are dehydrated or eating a low-salt diet. It also interacts with a number of commonly used medicines, including anti-inflammatories such as ibuprofen, blood pressure treatments such as Ace inhibitors like ramipril, and water tablets such as indapamide.
These interactions can push lithium levels higher in unpredictable ways, even when the dose being taken seems small. Too much lithium in the body can cause trembling, confusion, vomiting and, in serious cases, seizures.
Many of the low-dose products sold online contain a form called lithium orotate . This is different from the forms prescribed by doctors and is not held to the same safety and quality standards as prescription medicines. There are no large human trials directly comparing it with lithium carbonate or citrate.
Some doctors prescribe low-dose lithium orotate for mood symptoms that do not meet the criteria for bipolar disorder, but this is not backed by strong clinical evidence. Online, it is often sold with sweeping claims about mood, behaviour and memory that go well beyond what the research currently shows.
It is also worth being clear about what Lady Gaga actually said. She described taking prescription lithium - a regulated medicine used under medical supervision - not an over-the-counter supplement. The two are not the same thing.
Research into low-dose lithium and brain health is ongoing, and the early findings are worth watching. But early findings are not the same as answers.
Until large-scale trials show clearly that low-dose lithium is both safe and effective, taking it without medical guidance carries real risks - risks that are easy to miss when the focus falls on the possible benefits. Lithium is a genuinely important medicine. That is precisely why it should not be treated as a casual addition to a supplement routine.
Dipa Kamdar does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.
