Most people have never heard of the idea of using low-dose lithium as a supplement — for any disorder, including ADHD. But high-dose, pharmaceutical lithium had been approved by the FDA for “acute mania” and “recurrent” mania since at least the 1970s when it became the standard treatment for manic-depression.
In the 1990s, however, there were new medications to treat what was later termed “bipolar disorder” and pharmaceutical lithium became an afterthought.
But that doesn’t mean lithium itself has lost its therapeutic power or promise. In my clinical practice treating mental health disorders, low dose supplemental lithium is a viable treatment for ADHD.
There are quite a number of studies that show the effectiveness of lithium to ease irritation, anger, aggression and other symptoms of ADHD. And while these studies are on pharmaceutical lithium, my clinical experience tells me that nutritional lithium (much smaller supplemented doses) has a similar, and much safer, effect.
What the Studies Show About ADHD and Lithium Supplementation
Study 1:
This study found that lithium was twice as powerful as Ritalin for decreasing aggression.
A team of psychiatrists and neurologists studied young adults (average age 25) with ADHD, giving them either Ritalin or lithium for two months.1 Both groups had improvements in their symptoms—less aggression, irritability, impulsivity, hyperactivity, restlessness and antisocial behavior. But lithium outperformed Ritalin in several key categories.
Lithium decreased “aggressive outbursts” by 71%, compared to 26% for Ritalin. Decreased irritability by 42%, compared to 35% for Ritalin. And decreased antisocial behavior by 28%, compared to 20% for Ritalin.
Study 2:
This study looked at the effect of lithium on children with conduct disorder, and found there was less fighting, bullying, angry outbursts, hostility and hyperactivity with lithium.
Conduct disorder (CD) is found in 25% to 45% of children and adolescents with ADHD.2 CD is a pattern of emotional and behavioral problems like bullying, starting fights, stealing, lying, truancy and even more extreme antisocial behaviors like cruelty to animals and fire setting.
Anger and aggression are always part of the pattern.
In a study from psychiatrists at New York University Medical Center, 81 children hospitalized with “treatment-resistant” CD were given either lithium or Haldol (haloperidol), an antipsychotic drug.3 Although both drugs decreased symptoms, lithium was more effective in decreasing aggression and hostility.
Lithium outperformed Haldol in another way—lithium didn’t sedate the child; it solved the problem.
“When asked to characterize the actions of the two drugs,” wrote the psychiatrists, “the staff agreed that lithium reduced the explosiveness, and because of this, other positive changes took place, whereas haloperidol made the child only more manageable.”
They continued:
“Quite a few children receiving haloperidol said that they felt ‘slowed down,’ whereas children receiving lithium carbonate said they felt the drug ‘helped to control’ themselves.
Study 3:
A study in the Journal of the American Academy of Adolescent & Child Psychiatry looked at more children with CD.
50 children with conduct disorder, aged 5 to 12, were divided into two groups, with half taking lithium.4 After six weeks, those taking the mineral had less aggression, restlessness and a better attention span. “Lithium can be used in aggressive children,” concluded the study researchers.
Study 4:
Another small study of 40 children from the Archives of General Psychiatry (now JAMA Psychiatry) furthered the research.
Doctors studied 40 children (average age 12) with conduct disorder, giving 20 of them lithium.5 After one month, 16 were much less aggressive.
Study 5:
Another study6 published in the Journal of Child and Adolescent Pharmacology in 2014 focused on one patient in particular.
H., an 8-year-old girl, had been diagnosed with ADHD, disruptive behavior disorder (uncooperative, defiant and hostile behaviors) and mood disorder (irritability and depression). She’d been prescribed many medications, including stimulants, antidepressants and antipsychotics—none of which had improved her behavior.
H.’s problems, wrote her doctor, “included yelling, screaming, throwing things, hitting, biting and destroying property,” as well as “a very low frustration tolerance, and demonstrated hyperactivity, impulsivity and inattentiveness.”
H. was referred to a psychiatric clinic at the University of Arkansas for Medical Studies—and her psychiatrist, after having exhausted all his options, put her on lithium.
He describes what happened next:
“With the addition of lithium, H.’s symptoms improved remarkably. Her inattention, hyperactivity, and restlessness attenuated. Furthermore, her parents reported that her irritability was reduced by ‘60-70%.’ Sleep initiation improved, and she was able to sleep uninterrupted 6 – 7 hours every night. Improvement in her academic performance was noted, as concentration improved and hyperactivity decreased. Mood regulation was significantly improved as well.”
Balancing neurotransmitters in ADHD children
While far more studies are needed to further the understanding of how supplemental lithium can aid children suffering from ADHD and CD, the reasons why it might be beneficial are generally understood.
Lithium is simply a restorative tonic for the brain, strengthening and protecting neurons (brain cells) and balancing levels of the neurotransmitters that allow neurons to communicate.
Lithium increases serotonin, a neurotransmitter that regulates mood and behavior. It also increases dopamine—a neurotransmitter well-known to play a key role in the symptoms of ADHD, with imbalanced levels triggering hyperactivity and mood swings.
It decreases the neurotransmitter glutamate, which can damage neurons if levels are too high. And it increases the action of monoamine oxidase (MAO), an enzyme that regulates neurotransmitters; low levels of MAO are linked to aggression.
The mineral may also protect neurons from excitotoxicity—damage or death by excessive stimulation from brain-based biochemicals. It also helps activate neurotrophins like BDNF (brain-derived neurotrophic factor), proteins that nourish and protect neurons. Additionally, lithium boosts levels of n-acetyl-aspartate, a biomarker for healthy neurons.
Lithium can even increase the amount of gray matter, where brain cells reside. But lithium doesn’t stop there.
Lithium can affect genes in the frontal cortex, the part of the brain that controls aggression. The mineral also decreases neuroinflammation in the brain, a factor in many chronic mental health disorders. Last but not least, lithium helps move vitamin B12 and folate into nerve cells—a must for a healthy brain and nervous system.
Know that there are many ways to help treat ADHD other than purely relying on side-effect inducing drugs. For more information on how vitamins and minerals like lithium can reduce or even eliminate the need for ADHD medicine, please see my award-winning book, Finally Focused.
Yours in health,
James M. Greenblatt, MD
Founder & Medical Director, Psychiatry Redefined
Want to learn effective nutritional and functional interventions to help your patients with ADHD?
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References
- Dorrego MF, et al. A randomized, double-blind, crossover study of methylphenidate and lithium in adults with attention-deficit/hyperactivity disorder: preliminary findings. The Journal Of Neuropsychiatry And Clinical Neurosciences, 2002 Summer;14(3):289-95.
- NRC on ADHD. What we know #5: ADHD and coexisting conditions. Landover, MD: National Resource Center on ADHD, 2004.
- Campbell M, et al. Behavioral efficacy of haloperidol and lithium carbonate. A comparison in hospitalized aggressive children with conduct disorder. Journal Of The American Academy Of Child And Adolescent Psychiatry, 1984 Jul;41(7):650-6.
- Campbell M, et al. Lithium in hospitalized aggressive children with conduct disorder: a double-blind and placebo-controlled study. Journal of the American Academy of Child and Adolescent Psychiatry, 1995 Apr;34(4):445-53.
- Malone RP, et al. A double-blind placebo-controlled study of lithium in hospitalized aggressive children and adolescents with conduct disorder. Archives Of General Psychiatry, 2000 Jul;57(7):649-54.
- Deepmala & Coffey B. Challenges in psychopharmacological management of a young child with multiple comorbid disorders, history of trauma, and early-onset mood disorder: the role of lithium. Journal Of Child & Adolescent Psychopharmacology, 2014 Nov;24(9):519-24.