Can I take over-the-counter (OTC) lithium supplements for therapeutic purposes?

Over-the-Counter Lithium Supplements: Safety and Recommendations

Over-the-counter lithium supplements are not recommended for therapeutic purposes due to significant safety concerns, lack of regulation, and potential for toxicity even at low doses. 1, 2

Safety Concerns with OTC Lithium

Regulatory and Monitoring Issues

• OTC lithium supplements (commonly sold as lithium orotate) are not FDA-approved for therapeutic use
• These supplements lack standardized dosing, quality control, and proper labeling 3, 4
• Prescription lithium requires regular monitoring of serum levels, kidney function, and electrolytes 2
• Lithium has a narrow therapeutic window, with toxic effects occurring at levels close to therapeutic levels 2

Documented Risks

• Case reports exist of toxicity from OTC lithium supplements despite their lower elemental lithium content 4
• In one case, an 18-year-old developed lithium toxicity (serum level 0.40 mEq/L) after ingesting an OTC lithium supplement called "Find Serenity Now" 4
• Another case reported confusion in a patient taking OTC lithium orotate obtained via the internet 3

Medical Guidelines on Lithium Use

Prescription Requirements

• Clinical guidelines clearly identify lithium as a medication requiring:
  • Precise dosing based on serum levels 5
  • Regular monitoring of kidney function 1
  • Electrolyte monitoring 1
  • Professional supervision 2

Specific Monitoring Requirements

• KDIGO guidelines recommend that "all people taking potentially nephrotoxic agents such as lithium and calcineurin inhibitors should have their GFR, electrolytes and drug levels regularly monitored" (1A recommendation - highest level) 1
• Lithium is specifically identified as a medication requiring temporary discontinuation during serious intercurrent illness in patients with reduced kidney function 1

Risks in Special Populations

Kidney Function Concerns

• Lithium can cause diminished renal concentrating ability, presenting as nephrogenic diabetes insipidus 2
• Long-term use may be associated with morphologic changes including glomerular and interstitial fibrosis 2
• Patients with GFR <60 ml/min/1.73 m² are at higher risk of lithium toxicity 1

Other Side Effects

• Dermatologic effects including psoriasis exacerbation, alopecia, acne, and maculopapular eruptions can occur even at therapeutic levels 6
• Neurological effects including tremor and confusion can occur 4
• Endocrine effects including thyroid dysfunction may develop 1

Potential Benefits of Low-Dose Lithium

While some research suggests potential benefits of low-dose lithium (≤0.5 mM) for cardiovascular, musculoskeletal, metabolic, and cognitive function 7, these findings:

• Are preliminary and require further research
• Do not justify unsupervised self-medication
• Do not address the lack of standardization in OTC products

Recommendations for Those Seeking Mood Support

1. Consult a healthcare provider for proper evaluation and evidence-based treatment options
2. Avoid self-medicating with OTC lithium supplements 1
3. Be aware that herbal remedies and supplements should be discussed with healthcare providers, especially for those with chronic conditions 1
4. Consider FDA-approved alternatives for mood disorders under proper medical supervision

Conclusion

The risks of OTC lithium supplements outweigh any potential benefits. The lack of standardization, monitoring, and medical oversight creates unnecessary dangers. If you're experiencing mood symptoms that make you consider lithium supplementation, please consult with a healthcare provider for proper evaluation and evidence-based treatment options.