Should We Be Putting Lithium in Our Water?

Trace amounts of the element has been linked to lower levels of crime and suicide.

Jesse Hicks

Bill Diodato/H. Armstrong Roberts/ClassicStock/Getty Images

Jaime Lowe was 16 when she began communicating telepathically with Michael Jackson. For months her thoughts raced; she ate little and didn't sleep. One day she left home planning to free the King of Pop by removing all of his masks, which only she could see. There was a secret tunnel to Neverland, and though it might not be safe, it was a place she could go, a last resort for a teenager who'd been called on to save the world—the only one who could.

The world was against her; so were the Nazis, and her parents. Instead of Neverland, she arrived at the hospital, where it took four orderlies to hold her down while a nurse injected her with medication. She was diagnosed with bipolar disorder, a mental health condition marked by extreme mood swings, from manic episodes to depressive states, and even times that combine elements of the two.

Bipolar disorder is difficult to treat; typically the first medication doctors try is lithium, a mood-stabilizing drug. About a third of patients respond well to lithium—it completely prevents episodes. Lowe was one of those lucky ones. Her grandiose delusions ebbed, and she returned to (pretty close to) "normal." She continued to use lithium for more than 20 years; her memoir about the experience, Mental: Lithium, Love, and Losing My Mind, was published this month.

Remarkably, given its profound effect on her moods, Lowe says lithium didn't fog her personality. "How it feels to be on lithium is really hard to describe, because I don't feel it," she says. "Lithium was always this miracle drug for me, because it didn't feel like it affected who I was. I didn't recognize it as being a central part of my personality or anything that really changed the norm. It was just there, and it helped me. And I knew it helped me. And I knew I needed it."

While lithium was approved to treat bipolar disorder by the Food and Drug Administration in 1970, its history as a psychiatric treatment goes back much further. A mid-19th century London physician prescribed it for "brain gout," an early conceptualization of depression; another recommended it for "general nervousness." In 1871, lithium was first used to treat mania.

Those early psychiatric uses were themselves part of a longer history. Lithium is a naturally occurring element, a salt; it doesn't need to be synthesized in a lab, because it's already found, in varying concentrations, around the world. (More than half the world's lithium reserves lie beneath vast salt flats in Bolivia.) That ubiquity means it's in groundwater, usually in trace amounts—you've almost certainly drunk lithium without even knowing.

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Places with high concentrations of the element often have a reputation for their "healing waters." Lithia Springs, Georgia, for example, enjoyed a boom in the early 1900's, trading on a reputation supposedly going back to the Cherokees for its curative spring waters. Four presidents visited the resort; Mark Twain even stopped by.

It's not clear whether the famously skeptical Twain bought into the lithium-water pitch. The Food and Drug Administration cracked down on the health claims, and public interest waned. (In the early 1980s, a company resumed selling bottled water from Lithia Springs, with at least one customer drinking it to treat bipolar disorder.)

Scientifically, it's hard to speculate how trace amounts of lithium might have healing effects; even today, it's not clear the exact mechanism through which the element helps with bipolar disorder, though a recent, very early study has offered some clues. Therapeutic doses of lithium are much, much higher than what you'd get drinking some of Georgia's famous "love water."

Yet that doesn't mean that lithium water is just another species of snake oil. Many studies, stretching back decades, have suggested tantalizing correlations between trace amounts of lithium and mental health.

One of the earliest studies, published in 1990, used data from 27 different counties in Texas between 1978 and 1987. It showed that incidences of suicide, homicide, and rape were significantly higher in counties with little or no lithium in their drinking water. Rates of robbery, burglary, and theft showed a similar correlation, as did arrests for possession of opium, cocaine, and their derivatives. Rates of arrest for marijuana, driving while intoxicated, and drunkenness showed no association.

The study, which admittedly could only draw a correlation and not prove causation, wasn't the first to suggest that lithium's health benefits weren't only real, but already having widespread effect. Time magazine had said as much in 1971, calling it "the Texas tranquilizer," citing Earl B. Dawson, a University of Texas biochemist who studied urine samples to argue that El Paso had less crime than Dallas in part thanks to more lithium in its drinking water.

Stephen King spun the story into pop culture with his 1986 story, "The End of the Whole Mess," in which a benevolent genius spikes the world's water supply with a Texas tranquilizer. He thinks he's cured human beings of violence, only to realize, too late, that he's failed to recognize some serious side-effects. (The TV adaptation, starring Office Space's Ron Livingston, is surprisingly good.)

Since that Texas study, researchers have further examined the effects of lithium in drinking water. A 2013 review associated lower suicide rates across the Lonestar State where the water contained more lithium; similar results have been found in parts of Japan, Austria, and Greece. (A study in England seemed to find no correlation, but also dealt with much lower levels of lithium.) Researchers have also studied lithium's neuroprotective effects, which may preserve cognitive function in bipolar patients, and even those with Alzheimer's. Early studies have shown an association between certain concentrations of lithium in tap water and lowered rates of dementia.

Such promising indicators have led some experts to ask, as psychiatrist Anna Fels put it in a New York Times opinion piece, "Should we all take a bit of lithium?" Making the case that we should at least consider it, Fels describes lithium as "the Cinderella of psychotropic medications, neglected and ill used." Its usefulness in suicide prevention and treating bipolar disorder is firmly established.

In 2011, she notes, suicide was the 10th leading cause of cause of death in the United States. The US suicide rate climbed 24 percent between 1999 and 2014. Maybe widespread lithium treatment would change those numbers, providing inexpensive treatment for the vast many instead of the targeted few. Violent crime might decrease, and we might lower dementia rates across the population. Lithium might change the world—but we can't say for sure. "We don't know," Fels concludes, "because the research hasn't been done."

Francis Mondimore, director of the Mood Disorders Clinic at Johns Hopkins Bayview Medical Center, says the problem is slightly more complicated than that. There's much we do know, much we don't, and plenty of common sense barriers to recommending lithium for everyone. "This research has been going on for a long time," he says, "and there's definitely something there." Lithium hasn't yet given up its secrets. "It has a very complex effect in many different systems within the brain," Mondimore says. "That has made it very difficult to know which one of them or which several of them might be responsible for the benefits of lithium treating mood problems."

And treating mood problems is very different than offering lithium as a general health tonic. Carefully controlled, physician-monitored treatment has helped many people with diagnosable illness; dosing water to lower suicide rates and prevent dementia would be something else—a large-scale public health project. "Psychiatrists," Mondimore says, "don't give medicine to people who don't have mental illness." Offering medicine to apparently healthy people would require compelling evidence that we just don't have—yet.

It would also require a better understanding of the risks, as well as the benefits. Mondimore points out that while psychiatrists have gotten better at managing lithium's side effects, they're still a concern. Kidney damage, for example, can affect long-time patients. After 24 years of lithium, Lowe says, "I have the kidneys of a sixty year-old, which as a 40-year-old is not the best thing to hear. But it's also not, you know, dead." She traded lithium for Depakote, another medication that's shown to control the symptoms of bipolar disorder, and so far it's working. "I got 24 years of really good life out of lithium," she says, "and it allowed me to function. I wouldn't trade that." Widespread lithium use would demand a better understanding of similar trade-offs, and a decision about them, either collectively or individually.

These are theoretical considerations, but Mondimore suggests even more practical roadblocks. Who's going to fund a clinical trial on lithium, an inexpensive, unpatentable element? "Unfortunately, especially in the United States," he says, "clinical trials looking at the effectiveness of psychiatric medication are almost entirely funded by drug companies." They're not likely to spend money on research that can't return a profit.

Even if the evidence were strong enough to warrant a trial, it would require thousands of participants and millions of dollars. Mondimore compares it to adding fluoride to drinking water, or the fight to eradicate polio—a massive public health project. "That would be something that pretty much only the government is going to do unless Bill Gates gets interested in it," he say. "That might be what it would take, Bill Gates or Warren Buffett."

A billionaire bank account can speed up almost any project, but science moves slowly, cautiously. Lithium has had a remarkable run, from "brain gout" and "healing waters" to mainstream treatment. It still has a lot of potential, and our understanding of it continues to grow. As for whether we should all take a bit of lithium, though, the answer is probably not. At least, not yet.

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