Summary
Lithium orotate might be a good idea, especially for some people. It may have some risks too. We don’t really know. (Those who claim low risk don’t know either). You may be willing to pay for it, and maybe even take some risk. Do you want to be out front on this curve? For some people, that may be a risk worth taking.
What’s New in 2025?
Two significant developments have emerged:
- University of Saskatchewan Study: Researchers essentially repeated the experiments from the 1970s but using lower doses of lithium orotate. They found:
- Lithium orotate blocked manic behavior in mice better than lithium carbonate, even when the actual amount of lithium delivered via orotate was far lower
- Mouse kidneys were better off with low levels of lithium delivered via orotate than with anti-manic doses of lithium carbonate—not worse, as suggested in the 1979 study
- Lithium and Dementia Prevention: A follow-up to the key 2019 study tracked participants (average age 85) and found significantly better cognitive preservation in the lithium group compared to placebo, as measured by Mini-Mental Status Exam scores.
Who Might Consider Orotate?
There are at least three groups of people interested in lithium orotate:
- People wary of prescription lithium: For whom the idea of “lithium” as a drug from a psychiatrist is frightening—kidney risk, thyroid risk, side effects, “toxicity” if blood levels get too high, and the stigma of “serious mental illness.” An ultra-low-dose approach that might address mood problems while avoiding these issues appeals to many.
- People concerned about cognitive decline: If you had a parent with Alzheimer’s, wouldn’t you be interested in some ultra-low-dose, “water supply” level step you could take to lower your risk? Some people with family history or early signs of memory decline may feel they don’t have time to wait for further research.
- People interested in suicide prevention: A few might consider lithium orotate because tiny amounts of lithium in city water supplies have been correlated with lower suicide rates.
The key for all these groups is finding a dose so low it’s almost impossible to cause harm. But tiny-dose lithium marketed as a vitamin has created a significant market full of outrageous claims.
Let’s Calm Down
Let’s not judge lithium orotate as necessarily good just because it doesn’t require a prescription, nor necessarily bad because people sell it on the internet. I’ll even try to hold off judgment about how we may be losing a scientific mindset when leaping to this kind of thing without randomized trials versus placebo.
From that calm place, let me acknowledge that lithium orotate could be a good idea, especially for some people. And that, at the same time, we really don’t know. Remember, substances like this routinely get a 25-30% response rate because that’s the placebo response rate in mood and anxiety disorder studies.
The Research Data
The research landscape has evolved significantly:
- Two Brazilian Studies:
- First study used 300 micrograms daily and showed prevention of progression toward Alzheimer’s
- Second study used about 300 milligrams (blood level 0.2-0.4 mmol/L) but didn’t achieve statistical significance
- The 1979 Study: Found lithium orotate more harmful than conventional lithium carbonate to rat kidneys—but at very high doses (equivalent to full adult human dose)
- New Saskatchewan Research: Challenges the 1979 findings by showing better outcomes with low-dose lithium orotate than lithium carbonate
Safety Considerations
Lithium in the Water Supply
Lithium is found in the water supply of several cities worldwide (up to 170 mcg/L), and amazingly, those cities have lower suicide rates than nearby cities with little or no lithium in their water. While adding lithium to water supplies is unlikely to happen, lithium orotate offers individuals a way to self-administer low doses.
Thyroid Concerns
Lithium commonly causes thyroid problems (usually hypothyroidism, rarely hyperthyroidism). One person in 10 develops this at standard bipolar-treatment doses, and it’s far more common in women.
What would lithium orotate do to your thyroid? This hasn’t been well-studied. Maybe 300 micrograms poses very low risk, but once someone gets into the 300 milligram range, thyroid testing becomes necessary.
Dosage Comparison
| Form of lithium | Amount per pill/glass | Units per day | mg of lithium |
|---|---|---|---|
| Lithium carbonate | 150 mg | 1 | 14 mg |
| Lithium orotate (high dose) | 120 mg | 1 | 5 mg |
| Lithium orotate (low dose) | 5 mg | 1 | 0.2 mg |
| Texas groundwater (high) | 70 mcg/L | 8 8-oz glasses | 0.3 mg |
| Texas groundwater (low) | 170 mcg/L | 8 8-oz glasses | 0.1 mg |
Why Isn’t Lithium Orotate Replacing Lithium Carbonate?
Despite promising research:
- That’s one study so far, in mice
- Medical change is slow, which is sometimes good—”new” treatments can cause problems that don’t show up for years
- We’ve worked out what lithium blood levels are needed for treatment and prevention of mania with lithium carbonate over 50 years
- Switching to lithium orotate would require figuring this out all over again
Instead, lithium orotate is likely to become the routine pill for lithium when used to prevent dementia.
Conclusion
For patients with MCI (minimal cognitive impairment), I’m checking kidney function and in several cases prescribing lithium. This is based on the Brazilian studies and the substantial basic science suggesting this approach should help. Very-low-dose lithium is easier to use safely than full-dose lithium.
Could someone just start taking lithium orotate for the same reasons? I can see why someone would be tempted: get lithium’s potential brain benefits, no doctors, no blood tests. How big a dose can one take safely? Unknown. Is it safer to use lithium carbonate (say 150 mg, the lowest available prescription dose) than to use untested orotate? I think maybe so: at least that way you can get your kidney and thyroid checked too.
Lastly, does taking tiny-dose lithium, like in the first Brazilian study, accomplish anything? Now there’s something I’d love to know. When someone repeats that study, if they get the same result, I’d think nearly everyone would want a 300 mcg pill. Or come to Ashland, Oregon and have a sip from the public fountain once a day.
Help Advance the Research
A team at King’s College London is conducting research on lithium orotate experiences:
- Participate in one video interview (up to 1 hour)
- Share your personal experience with lithium orotate
- Contact: lily.chebabo-manning@kcl.ac.uk
Updated April 2025, with data from Dr Phelps’ latest website: Depression Education