Revista Internacional de Saúde Mental e Psiquiatria

Lithium: Implications for Neuropsychiatry and Wellness

Orestis Giotakos

Lithium is ubiquitous in the environment and probably an essential trace nutrient. The guidelines of major psychiatric association name lithium as a first-line therapy for bipolar disorder. Some studies have shown an association between low lithium intakes from water supplies and suicidality, as well as criminality. Other studies have shown that trace levels of lithium have neuroprotective abilities or improvements in mood and cognitive function. In animals, lithium upregulates neurotrophins, including brain-derived neurotrophic factor, nerve growth factor, neurotrophin-3, as well as receptors to these growth factors in brain. Lithium has been reported to be beneficial in animal models of brain injury, stroke, amyotrophic lateral sclerosis, spinal cord injury, and degenerative diseases. A wide range of intracellular responses may be secondary to the inhibition of glycogen synthase kinase-3 beta and inositol monophosphatase by lithium. In humans, lithium treatment has been associated with humoral and structural evidence of neuroprotection, such as increased expression of anti-apoptotic genes, inhibition of cellular oxidative stress, synthesis of brainderived neurotrophic factor, cortical thickening, increased grey matter density, and hippocampal enlargement. Many findings pose the question of whether the prospect of adding lithium to drinking water is realistic, weighing the benefits and potential risks. The bulk of evidence suggests that the optimum level of lithium intake is more than most people get from food and drinking water.