1) therapeutic doses of lithium as a prescription medicine for mood disorders are MUCH higher than doses occurring through lithium in the water supply, and yet
2) there is perhaps some epidemiological signal suggesting differing rates of suicide and depression in places where lithium levels in the water supply are higher.
Kay Redfield Jamison, author of some of the most compassionate books about depression you will ever read,[1] credits lithium with saving her life. I'm glad her life was spared so that she could write from the inside about what it is like to have a severe mood disorder, and apply her creativity to communicating with people who cannot directly understanding her personal experiences or the experiences of other patients.
I think the article's call for further research, at a minimum, is worth taking seriously. The neuroprotective effect of lithium demonstrated in animal studies (verified by necropsy and examination of the animal's brains after the animals die) is well established, so we may as well check whether adjustment of water supplies by intentional supplementation has a beneficial effect if (and only if) epidemiological studies and animal experiments suggest doing so. This is, after all, how the beneficial effects of fluoride on tooth enamel strength and resistance to decay were discovered.
The "benefits" of lithium come at a cost, which this article doesn't really address. Lithium evens out your emotions, good and bad, some describe it as "turning into a soulless robot." That could mean a more docile society (the legal, behavioral, etc benefits described) but sounds pretty close to THX 1138 to me.
I am bipolar. What you describe is why it's a "hard sell" to patients with mood disorders.
Yes, others will point to the higher dose for psychiatric patients.
I would point to the soulless robot, the empty husk of a once vibrant, creative brain.
We are devs, and our brain is our livelihood. In me it killed my creativity and my passion. Not only did I not want to code anything new, I could not conceive of new things. I stopped improv jams on guitar, I could not write songs. I became wonderfully adept at doing scales. Scales over and over.
I'll take my mood disorder- because it comes WITH emotions.
This is just to give you a 'crazy person's' impression of Lithium. Your results may vary.
I have been taking bipolar meds for a dozen years. Compared to atypical antipsychotics, benzos or other mood stabilizers, lithium is a walk in the park. I think the x hours of TV or internet 'use' a day makes a more docile society than a little lithium would.
Psychiatric doses, perhaps, but I don't think trace doses have any meaningful effect. The doses are an order of magnitude or two smaller, and my personal experience doesn't agree: when I ran a blind self-experiment for around a year using lithium orotate doses higher than the trace water proposals, I noticed nothing subjectively and none of my recorded data changed (http://www.gwern.net/Nootropics#lithium-experiment), so I'm fairly skeptical of the claim.
Lithium is not like you describe. I've taken half a dozen SSRI's, which at times made me feel totally empty and without motivation. I've taken one antipsychotic (risperidone) and it made me feel like an utterly stupid zombie, so much so that I stopped taking it against my doctor's orders. I was put on lithium and I found that I'm completely capable of feeling a full range of emotions, but what I don't experience is the accelerated spiraling of emotions that can send me into depression or mania. Compared to more recent psychotropic medications, lithium is pretty mild in terms of unwanted side effects; the only drawback is that if you're on a high dose, you have to stay hydrated to avoid lithium toxicity. That's a pretty small price to pay to stay level.
I'm not so sure a "more docile society" is a good thing - given that one of the definitions is "easily led or managed", which brings to mind dystopian government controls...
At prescription amounts, yes it pretty much turns the patient into a robot. My stepfather is bipolar, and his doctor had to stop prescribing him lithium because it stripped away his normally upbeat (when not in a depressive state) personality, to the point that he was difficult to interact with.
Again though, that's at prescription levels. Trace levels in drinking water probably won't make us all into soulless robots ripe for totalitarian rule.
Good timing. It happens I'm going to Ashland, OR next week. The town is famous for the Shakespeare Festival (world-class performances) and Lithia Park. The latter is a natural lithium containing mineral water source. It's easy to sample, just a short stroll from the Elizabethan theater, a drinking fountain bubbles up the spring water.
ATM I'm not sure of the exact concentration of the minerals, but from prior years, saying it tastes really bad isn't nearly a strong enough description. Other water supplies containing Li may be quite acceptable, but except for Ashland palatability isn't the main issue.
In the article, the cited concentration of Li at 0.170 mg/L, if referring to Li+ ion alone, the water supply would actually contain ~1/100 of the lowest therapeutic dose of Li. Medicinally Li is provided as the carbonate salt. A minimal dose is 300 mg/day, which contains ~ 30 mg elemental Li. Consuming Li-fortified water 2 L/d -> 0.34 mg Li or >1/100 of low medicinal Li dose .
Of course in nature Li is always in ionic or combined form, but the article didn't give details about Li concentrations, so it muddies the water trying to parse Li effects in any number of ways.
Here in Portland OR, city water is sourced high up near Mt. Hood from condensation of atmospheric water (mist or rain) and piped the short distance to the city. It's basically like distilled water, very low in mineral content. So low in fact, the federal government insists that alkaline minerals are added to the supply since distilled water is acidic and leaches lead from old plumbing.
Other data would show something different re: suicidal behavior but contradictory data sets are kind of the point.
Li could be a factor but I'm skeptical. We must remain alert to the hazards of drawing conclusions from population-based observational data. In this domain, experimental studies are difficult to design and conduct, but further study to narrow down confounding factors would be useful.
What I do know is water purity is sacred here. The last fluoridation campaign failed by about a 3:1 lopsided vote.
What chance would there be of adding lithium to our water supply? I think it would not be voted in.
Distilled water is neutral, it is the reference point against which acidic and alkaline solutions are compared.
Technically one could argue that it is acidic, because any concentration of [H+] is acidic, but this is like arguing that Jiminy Cricket is tall because he has height.
However, rainwater will naturally absorb CO2 in the air (and since the industrial revolution, NO2 and SO3), making it acidic.
> Medicinally Li is provided as the carbonate salt. A minimal dose is 300 mg/day, which contains ~ 30 mg elemental Li.
Lithium carbonate is about 19 % elemental lithium by mass (lithium carbonate contains two lithium atoms per molecule), so 300 mg would be ~ 57 mg lithium.
Also, to my knowledge, the typical therapeutic doses are at least 900 mg/d in adults.
I live about 3 miles away from Lithia Springs, but I can't seem to find any information online about how much lithium is actually in our drinking water.
I know our water and sewer authority publishes a report on water quality each year, but I don't remember seeing lithium content in the report.
I'm just inside Paulding County with a Powder Springs address, and that's who I pay my water bill to, but the yearly water quality reports I get come from Cobb County. It makes me wonder if Lithia Springs even gets their municipal supply from the spring, or from a Douglas County source.
> I can't seem to find any information online about how much lithium is actually in our drinking water.
Not too surprising: I've done some poking around looking for datasets measuring lithium in drinking waters (the existing epidemiological work is, IMO, surprisingly small-n for something that seems to be routinely measured by drinking water systems), and it's pretty hard to find any lithium measurements.
Not to detract from the flow of the conversation, but do any of us Atlanta-area hackers have any formal events or get-togethers? I'd love to meet some of you and hack on stuff.
Other uses for very-sensitive analysis of waste water include real time drug sampling. We can tell that it's the weekend by the amounts of MDMA and cocaine (metabolites?) in the water; where heroin doesn't show weekend spikes. This can be used at festivals to see if "legal highs" are actually used and in what kind of quantities.
The programme is better than this page makes it out to be.
I live just a couple of miles from Lithia Springs, Georgia, and oddly enough I've never seen "Lithia Water" on sale anywhere around here. I suppose it gets bottled and sold to retailers in other states.
As for lithium-infused water chilling people out; well, I've lived here long enough to know that I wouldn't walk the streets of Lithia Springs at night. There are some rowdy people living there. Maybe they all drink Dasani or Aquafina instead of the local tap water.
> The authors discovered that people whose water had the least amount of lithium had significantly greater levels of suicide, homicide and rape than the people whose water had the higher levels of lithium. The group whose water had the highest lithium level had nearly 40 percent fewer suicides than that with the lowest lithium level.
I can't but help wonder whether higher levels of lithium also correlate with a clean water supply, which would indicate a more affluent community. It may simply be the case that those areas with cleaner water have a better economy, and thus less crime, etc. Although lithium undoubtedly has antidepressant effects.
It's funny this article popped up on here. Today I was actually reading about how chromium picolinate was found to have a positive effect on those with atypical depression. It can be purchased from any vitamin store. It makes me wonder if trace elements (lithium, chromium, etc.) are vital to the brain's proper functioning via some as yet undiscovered mechanism.
Also, why is it that you have to have a prescription to get certain compounds, but other ones you can just purchase yourself? Is it simply the potential for toxicity?
> I can't but help wonder whether higher levels of lithium also correlate with a clean water supply, which would indicate a more affluent community.
Not likely, because the water supply of an affluent community would have highly filtered water containing few "impurities" including lithium. Further, if the community in question were conservative in their political views, the water might even lack fluoride, another component with known beneficial traits but one that has become a political issue in some places.
> Also, why is it that you have to have a prescription to get certain compounds, but other ones you can just purchase yourself? Is it simply the potential for toxicity?
No, it revolves around the issue of medical applications. If a substance has known medical applications, then its dissemination will likely be controlled by the FDA. Even advertising a substance's possible medical benefits is not permitted in the general case, without FDA approval and substantial controls. For example, if I sell willow bark as writing paper, no problem. If I sell it as a pain-killer without possessing medical authority, I will be in a heap of trouble.
> I can't but help wonder whether higher levels of lithium also correlate with a clean water supply, which would indicate a more affluent community. It may simply be the case that those areas with cleaner water have a better economy, and thus less crime, etc.
I don't think it would. Typically both rich and poor communities would only be enforcing the FDA ceiling on lithium levels, which seems to be high enough that remediation is rarely (ever?) necessary, so rich/poor wouldn't correlate with levels much if all. The confounds which have come up as particularly plausible tend to deal with locations of mental hospitals, urban vs rural, and local food consumption.
Mostly a reasonable and interesting article. But when you talk about adding something psychoactive to the drinking water, it's just a horrible idea.
It doesn't matter if it's otherwise natural. Nature is inconsistent in dosages (so diverse perspectives can flourish) and doesn't have ulterior motives.
Maybe it brings down suicide rates, but what other effects does it have? Does it affect the likelihood of voting for a political party or cause? Does it affect the likelihood of political participation in general?
It's kind of like CO2 levels in the atmosphere. Higher levels will have some effect; we're basically arguing over the significance of it, what to do about it (if anything), and whether politicians can be trusted with the power to make those changes.
Similarly, mind-altering substances will affect aggregate political behavior. Once someone finds out how, they will use it to their advantage.
I think you've hit on something very fundamental here. When the government has well targeted interventions that achieve specific goals, this can be a good thing.
But the cumulative effect of many social interventions can give the government excessive power. Even beside purely political concerns, I think we have to ask whether we prefer the random hand dealt by nature, to a hand carefully chosen by the government.
Nate Silver gives a talk [1] describing how we could design cities to make people less "racist". If this was possible, it would represent an overtly political manipulation of the populace. Chemicals probably can't have such target effects, but they still raise the question of what rights the government has to manipulate people's behavior.
If there is a concrete correlation between trace amounts of Lithium in the water supply and lower suicide rates, surely there are other effects? The studies done seem quite one sided to me (or more likely, this article is). For serious consideration, not only do more studies have to be undertaken for other cities, but other factors have to be measured as well. Other psychological problems, rate of divorce, physical activity (sport etc), unemployment, debt, other drug use, education etc. Perhaps there's a lower incidence of suicide because people are much less active? Unemployed, no ambition, but not enough drive to end it all as well?
The answer is that, as one moves into more behaviors and more detail, the chance to meaningfully correlate outcomes with lithium exposure becomes more difficult. Also, because no one knows why those correlations exist (why lithium has the effect it does), it's not possible to turn a correlation into a rigorous, scientific cause-effect relationship.
The gold standard in science is not a correlation, but a cause-effect relationship accompanied by an explanation. With respect to lithium, we're a long way from that goal.
"But there are undoubtedly other reasons for its neglect. Pharmaceutical companies have nothing to gain from this cheap, ubiquitous element."
It's a tragic condemnation of the way we do health and nutrition that if no one profits from marketing and selling something, the masses typically won't hear about the benefits of it.
http://en.wikipedia.org/wiki/Lithium_(medication)#Side_effec...
The dosages required to achieve "beneficial" psychoactive effects will probably result in adverse side effects in a significant portion of the population. Lithium should be prescribed by a doctor on a case by case basis, not indiscriminately dumped into the water supply.
[+] [-] tokenadult|11 years ago|reply
1) therapeutic doses of lithium as a prescription medicine for mood disorders are MUCH higher than doses occurring through lithium in the water supply, and yet
2) there is perhaps some epidemiological signal suggesting differing rates of suicide and depression in places where lithium levels in the water supply are higher.
Kay Redfield Jamison, author of some of the most compassionate books about depression you will ever read,[1] credits lithium with saving her life. I'm glad her life was spared so that she could write from the inside about what it is like to have a severe mood disorder, and apply her creativity to communicating with people who cannot directly understanding her personal experiences or the experiences of other patients.
I think the article's call for further research, at a minimum, is worth taking seriously. The neuroprotective effect of lithium demonstrated in animal studies (verified by necropsy and examination of the animal's brains after the animals die) is well established, so we may as well check whether adjustment of water supplies by intentional supplementation has a beneficial effect if (and only if) epidemiological studies and animal experiments suggest doing so. This is, after all, how the beneficial effects of fluoride on tooth enamel strength and resistance to decay were discovered.
[1] http://www.amazon.com/Kay-Redfield-Jamison/e/B000AQ1IC8
[+] [-] hammock|11 years ago|reply
[+] [-] fifthesteight|11 years ago|reply
Yes, others will point to the higher dose for psychiatric patients.
I would point to the soulless robot, the empty husk of a once vibrant, creative brain.
We are devs, and our brain is our livelihood. In me it killed my creativity and my passion. Not only did I not want to code anything new, I could not conceive of new things. I stopped improv jams on guitar, I could not write songs. I became wonderfully adept at doing scales. Scales over and over.
I'll take my mood disorder- because it comes WITH emotions.
This is just to give you a 'crazy person's' impression of Lithium. Your results may vary.
[+] [-] nutate|11 years ago|reply
The article omits 7up (which contained lithium for a while) and lithia water which you can buy online right now: http://lithiamineralwater.com/store.htm
[+] [-] gwern|11 years ago|reply
[+] [-] dozenal|11 years ago|reply
[+] [-] KrisAndrew|11 years ago|reply
[+] [-] userbinator|11 years ago|reply
[+] [-] phkahler|11 years ago|reply
But doesn't pot bring apathy? People are actually starting to legalize that...
[+] [-] morganvachon|11 years ago|reply
Again though, that's at prescription levels. Trace levels in drinking water probably won't make us all into soulless robots ripe for totalitarian rule.
edit: missing words
[+] [-] Houshalter|11 years ago|reply
[+] [-] jrapdx3|11 years ago|reply
ATM I'm not sure of the exact concentration of the minerals, but from prior years, saying it tastes really bad isn't nearly a strong enough description. Other water supplies containing Li may be quite acceptable, but except for Ashland palatability isn't the main issue.
In the article, the cited concentration of Li at 0.170 mg/L, if referring to Li+ ion alone, the water supply would actually contain ~1/100 of the lowest therapeutic dose of Li. Medicinally Li is provided as the carbonate salt. A minimal dose is 300 mg/day, which contains ~ 30 mg elemental Li. Consuming Li-fortified water 2 L/d -> 0.34 mg Li or >1/100 of low medicinal Li dose .
Of course in nature Li is always in ionic or combined form, but the article didn't give details about Li concentrations, so it muddies the water trying to parse Li effects in any number of ways.
Here in Portland OR, city water is sourced high up near Mt. Hood from condensation of atmospheric water (mist or rain) and piped the short distance to the city. It's basically like distilled water, very low in mineral content. So low in fact, the federal government insists that alkaline minerals are added to the supply since distilled water is acidic and leaches lead from old plumbing.
However, Portland has among the lowest suicide attempt rates in the US. Our neighbor to the north, Seattle WA is among the highest, along with Salt Lake City UT and Dallas TX. http://socialcapitalreview.org/seattle-region-ranks-2nd-of-3...
Other data would show something different re: suicidal behavior but contradictory data sets are kind of the point.
Li could be a factor but I'm skeptical. We must remain alert to the hazards of drawing conclusions from population-based observational data. In this domain, experimental studies are difficult to design and conduct, but further study to narrow down confounding factors would be useful.
What I do know is water purity is sacred here. The last fluoridation campaign failed by about a 3:1 lopsided vote.
What chance would there be of adding lithium to our water supply? I think it would not be voted in.
[+] [-] klodolph|11 years ago|reply
Distilled water is neutral, it is the reference point against which acidic and alkaline solutions are compared.
Technically one could argue that it is acidic, because any concentration of [H+] is acidic, but this is like arguing that Jiminy Cricket is tall because he has height.
However, rainwater will naturally absorb CO2 in the air (and since the industrial revolution, NO2 and SO3), making it acidic.
[+] [-] ozy23378|11 years ago|reply
Lithium carbonate is about 19 % elemental lithium by mass (lithium carbonate contains two lithium atoms per molecule), so 300 mg would be ~ 57 mg lithium. Also, to my knowledge, the typical therapeutic doses are at least 900 mg/d in adults.
[+] [-] 31reasons|11 years ago|reply
I can imagine posters like "The government wants to drug us".
[+] [-] andyidsinga|11 years ago|reply
agreed, after the fluoride campaign, no way in hell adding Li will pass.
[+] [-] efm|11 years ago|reply
1000x .170mg is "1,000 times less than a fifth of a milligram," not 1000 times a fifth of a gram.
http://www.gwern.net/Nootropics#lithium has a significant number of references to the literature on lithium, and is worth reading.
[+] [-] meowface|11 years ago|reply
Honestly, his writeups on most things are pretty spot on.
[+] [-] emmelaich|11 years ago|reply
Better is 'one thousandth of a fifth of a milligram'
[+] [-] learc83|11 years ago|reply
I know our water and sewer authority publishes a report on water quality each year, but I don't remember seeing lithium content in the report.
[+] [-] morganvachon|11 years ago|reply
[+] [-] gwern|11 years ago|reply
Not too surprising: I've done some poking around looking for datasets measuring lithium in drinking waters (the existing epidemiological work is, IMO, surprisingly small-n for something that seems to be routinely measured by drinking water systems), and it's pretty hard to find any lithium measurements.
[+] [-] possibilistic|11 years ago|reply
[+] [-] batbomb|11 years ago|reply
[+] [-] DanBC|11 years ago|reply
People take medication and excrete some of it.
Sensible water use, especially in drought areas, means that water is reused - the water you drink has gone through someone else before you.
BBC Radio Four has a programme about this: "Urine Trouble: what's in our water?"
http://bbc.co.uk/news/health-29108330
Other uses for very-sensitive analysis of waste water include real time drug sampling. We can tell that it's the weekend by the amounts of MDMA and cocaine (metabolites?) in the water; where heroin doesn't show weekend spikes. This can be used at festivals to see if "legal highs" are actually used and in what kind of quantities.
The programme is better than this page makes it out to be.
[+] [-] morganvachon|11 years ago|reply
As for lithium-infused water chilling people out; well, I've lived here long enough to know that I wouldn't walk the streets of Lithia Springs at night. There are some rowdy people living there. Maybe they all drink Dasani or Aquafina instead of the local tap water.
[+] [-] Xcelerate|11 years ago|reply
I can't but help wonder whether higher levels of lithium also correlate with a clean water supply, which would indicate a more affluent community. It may simply be the case that those areas with cleaner water have a better economy, and thus less crime, etc. Although lithium undoubtedly has antidepressant effects.
It's funny this article popped up on here. Today I was actually reading about how chromium picolinate was found to have a positive effect on those with atypical depression. It can be purchased from any vitamin store. It makes me wonder if trace elements (lithium, chromium, etc.) are vital to the brain's proper functioning via some as yet undiscovered mechanism.
Also, why is it that you have to have a prescription to get certain compounds, but other ones you can just purchase yourself? Is it simply the potential for toxicity?
[+] [-] lutusp|11 years ago|reply
Not likely, because the water supply of an affluent community would have highly filtered water containing few "impurities" including lithium. Further, if the community in question were conservative in their political views, the water might even lack fluoride, another component with known beneficial traits but one that has become a political issue in some places.
> Also, why is it that you have to have a prescription to get certain compounds, but other ones you can just purchase yourself? Is it simply the potential for toxicity?
No, it revolves around the issue of medical applications. If a substance has known medical applications, then its dissemination will likely be controlled by the FDA. Even advertising a substance's possible medical benefits is not permitted in the general case, without FDA approval and substantial controls. For example, if I sell willow bark as writing paper, no problem. If I sell it as a pain-killer without possessing medical authority, I will be in a heap of trouble.
[+] [-] gwern|11 years ago|reply
I don't think it would. Typically both rich and poor communities would only be enforcing the FDA ceiling on lithium levels, which seems to be high enough that remediation is rarely (ever?) necessary, so rich/poor wouldn't correlate with levels much if all. The confounds which have come up as particularly plausible tend to deal with locations of mental hospitals, urban vs rural, and local food consumption.
[+] [-] ConceptJunkie|11 years ago|reply
[+] [-] fnordfnordfnord|11 years ago|reply
Probably not. Acetaminophen is otc, yet rather toxic. I've always thought it was the potential to have unearned fun.
[+] [-] jeffdavis|11 years ago|reply
It doesn't matter if it's otherwise natural. Nature is inconsistent in dosages (so diverse perspectives can flourish) and doesn't have ulterior motives.
Maybe it brings down suicide rates, but what other effects does it have? Does it affect the likelihood of voting for a political party or cause? Does it affect the likelihood of political participation in general?
It's kind of like CO2 levels in the atmosphere. Higher levels will have some effect; we're basically arguing over the significance of it, what to do about it (if anything), and whether politicians can be trusted with the power to make those changes.
Similarly, mind-altering substances will affect aggregate political behavior. Once someone finds out how, they will use it to their advantage.
[+] [-] DanBC|11 years ago|reply
Should we remove trace amounts of lithium from water in areas where it's naturally occurring?
[+] [-] QuantumChaos|11 years ago|reply
But the cumulative effect of many social interventions can give the government excessive power. Even beside purely political concerns, I think we have to ask whether we prefer the random hand dealt by nature, to a hand carefully chosen by the government.
Nate Silver gives a talk [1] describing how we could design cities to make people less "racist". If this was possible, it would represent an overtly political manipulation of the populace. Chemicals probably can't have such target effects, but they still raise the question of what rights the government has to manipulate people's behavior.
[1] https://www.ted.com/talks/nate_silver_on_race_and_politics
[+] [-] afro88|11 years ago|reply
[+] [-] lutusp|11 years ago|reply
The gold standard in science is not a correlation, but a cause-effect relationship accompanied by an explanation. With respect to lithium, we're a long way from that goal.
[+] [-] sethbannon|11 years ago|reply
It's a tragic condemnation of the way we do health and nutrition that if no one profits from marketing and selling something, the masses typically won't hear about the benefits of it.
[+] [-] Symmetry|11 years ago|reply
http://slatestarcodex.com/2014/06/15/fish-now-by-prescriptio...
[+] [-] andylei|11 years ago|reply
[+] [-] refurb|11 years ago|reply
[+] [-] cbd1984|11 years ago|reply
Really, it's a horrible argument. It presupposes that everyone working for Big Pharma is a sociopath who only cares about the next quarterly report.
[+] [-] unknown|11 years ago|reply
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