Lithium (Mood Stabilizer)
Common brand names: Lithobid, Eskalith, lithium carbonate
Three nutrients listed against this medication. The most severe is marked critical.
At a glance
None of the three is marked well documented. Each row carries its own evidence level.
At a glance
- SodiumCritical · Traditionally cited, limited evidence
- InositolModerate · Moderate evidence
- MagnesiumMild · Traditionally cited, limited evidence
Color shows how serious each listed effect is. The label beside it shows how strong the evidence is. The cards below explain each one and show its evidence.
Nutrients it can lower
Mechanism, This is a monitoring interaction rather than a depletion. Lithium competes with sodium for reabsorption in the kidney, so when sodium falls (through dehydration, fluid loss, or a low-salt diet) the kidney retains more lithium and blood levels can climb toward the toxic range. The FDA Black Box Warning refers to this interaction. Lithium does not deplete sodium; unstable sodium destabilizes lithium.
Common signs, Tremor, confusion, lithium toxicity, cardiac arrhythmia at toxic levels
Norman and Burrows (Clinical Pharmacokinetics, 1984; PMID PubMed ID: the permanent number the US National Library of Medicine gives a published paper. Each one links to that paper's record on PubMed. 6380872): renal lithium clearance tracks sodium status in patients, so sodium depletion raises serum lithium toward the toxic range at an unchanged dose.
Consistent sodium intake is maintained on lithium, sodium is not restricted, and intake is increased during exercise, heat or illness, because sodium loss raises lithium levels. The 2,000–3,000 mg/day figure is a general intake range in common use, not from a trial cited on this row.
Mechanism, Lithium has been proposed to increase urinary magnesium loss and to interact with magnesium-dependent enzyme systems. Measured directly, chronic lithium is generally associated with unchanged or slightly higher magnesium rather than lower. The depletion direction is theoretical and is not the direction the available data show.
Common signs, Tremor (worsened), muscle weakness, cognitive fog, insomnia
Chronic lithium is generally associated with unchanged or increased magnesium, not depletion. Theoretical.
Magnesium glycinate was used at 200–300 mg daily; magnesium oxide is generally avoided. This is discussed with the prescriber, since magnesium can affect lithium levels.
Mechanism, Lithium's primary action is inhibition of inositol monophosphatase, depleting cellular free inositol and affecting downstream signaling.
Common signs, Psoriasis (lithium side effect linked to inositol), dry skin, cognitive effects
Berridge et al. (Cell, 1989; PMID 2553271) established the inositol depletion hypothesis of lithium action.
Inositol 2–4 g daily is a range in common use, not from a trial cited on this row. Berridge set out the inositol-depletion hypothesis of lithium action and tested no supplement and no skin endpoint The outcome a trial measures to decide whether the treatment worked, such as heart attacks, blood pressure or a symptom score..
For your next appointment
It prints or saves as a single page. Whether to add a supplement for a nutrient this medication may lower is a decision for your prescriber.
Disclosure
These statements have not been evaluated by the Food and Drug Administration. Any grade on this page describes the strength of published human trial evidence in the populations studied. It is not a recommendation for any individual and is not medical advice. Starting, stopping or changing any supplement or medication is a decision for your physician.
Grades move when new trials publish. A free monthly email lists every grade EBL moved, with the reason and the trial behind it: the sign-up is on the Evidence Log →