This is the low lithium questionnaire that I use with new clients in order for us to figure out if a trial of low dose lithium, in the form of lithium orotate, may be helpful. The hallmark of low lithium is a rollercoaster of emotions. Keep in mind that this is just one of 12 questionnaires that I have my clients complete. Many of the following symptoms can have multiple causes, the labs may relate to other deficiencies and the conditions have other root causes. This questionnaire simply provides additional evidence that lithium orotate may help.
We typically do a lithium orotate trial, starting with 5 mg once a day, and going up to 10 mg twice a day. We do this after we have started trialing the respective amino acids for low serotonin, low GABA, low endorphins, low catecholamines and low blood sugar. A big clue that lithium orotate may be helpful (when many of the symptoms below are checked off) is when the amino acids for low serotonin (tryptophan or 5-HTP), low GABA (GABA or theanine), low endorphins (DPA or DLPA), low catecholamines (tyrosine or DLPA) and low blood sugar (glutamine) are not as effective as expected (based on the amino acids mood/neurotransmitter questionnaire).
Low lithium questionnaire
Symptoms
Mood swings (a rollercoaster of emotions)
Addictions and/or cravings
Depressed
Low self-esteem
Boredom
Easily distracted
Rebellious, disruptive behavior and/or aggressiveness
Irritability
Restless/internal anxiety (similar to low serotonin worry/ruminating anxiety)
Restless/external anxiety (similar to low GABA physical anxiety)
Anxiety ups and downs (fluctuations)
Melancholic pessimism
Suicidal thoughts
Disorganized with planning difficulties
Focus issues/ADHD
Insomnia
Procrastination and/or no initiative
Jack of all trades, master of none
Impulsive and/or lacking tact
Poor insight
Risky behavior
Cognitive issues
Migraines or cluster headaches
Effectiveness of amino acids
The amino acids for low serotonin, low GABA, low endorphins, low catecholamines and low blood sugar are not as effective as expected (based on the amino acids mood/neurotransmitter questionnaire)
Labs
Low white blood cell count
Low red blood cell count
Anemia
Low platelet count
Conditions
Anorexia nervosa
Heart disease (heart arrhythmias, history of heart attack)
Raised blood sugar or diabetes
Kleptomania
Alcoholism
Alzheimer’s disease
Fibromyalgia
Bipolar II
Gout
Hyperthyroidism
Nearsightedness or glaucoma
Herpes infections (current or prone to them)
If you are new to low dose lithium / lithium orotate
As I share in this blog, Upping my tryptophan and lithium orotate have been absolutely profound for me: I’ve been depression free and anxiety free for over a year, I’ve used lithium orotate with many clients and use it when folks have mood swings and anxiety ups and downs. It’s harder for the amino acids to work when there is a moving goal post and lithium orotate evens things out.
You can read Katrin’s wonderful results: “Upping my tryptophan dose and also including and upping the dose of lithium orotate has been absolutely profound for me. I’m off my SSRI/antidepressant (which I was off and on for a number of years). I’ve been depression/anxiety free for over a year. So fantastic.”
The above blog also includes additional information on the differences between low dose lithium / lithium orotate and prescription lithium carbonate. The latter is used at much higher doses and does have side-effects.
One of the many ways lithium works is via the impact on neurotransmitter production. This paper, Potential Mechanisms of Action of Lithium in Bipolar Disorder, states this: “At a neuronal level, lithium reduces excitatory (dopamine and glutamate) but increases inhibitory (GABA) neurotransmission.” It also increases protective proteins such as BDNF (brain-derived neurotrophic factor), helps reduce oxidative stress and is neuroprotective. This paper is referring to lithium carbonate and not lithium orotate but until we have more research on lithium orotate, I feel comfortable extrapolating, given what I’ve seen clinically with lithium orotate.
I’ve also blogged about low dose or microdose lithium here: Microdose lithium formulation is capable of halting signs of advanced Alzheimer’s and improving cognition. In a study published in 2020, “a team of researchers has shown that, when given in a formulation that facilitates passage to the brain, lithium in doses up to 400 times lower than what is currently being prescribed for mood disorders is capable of both halting signs of advanced Alzheimer’s pathology and of recovering lost cognitive abilities.” In this study, they used lithium citrate in similar doses as the lithium orotate i.e 3.2 mg to 6.4 mg NP03 based on 70kg of body weight (which is around 154.3 lbs).
Resources if you are new to using the amino acids as supplements (and where to get lithium orotate)
If you are new to using any of the amino acids as supplements, here is the Amino Acids Mood Questionnaire from The Antianxiety Food Solution (you can see all the symptoms of neurotransmitter imbalances).
If you suspect low levels of any of the neurotransmitters and do not yet have my book, The Antianxiety Food Solution – How the Foods You Eat Can Help You Calm Your Anxious Mind, Improve Your Mood, and End Cravings, I highly recommend getting it and reading it before jumping in and using amino acids on your own so you are knowledgeable. And be sure to share it with the practitioner/health team you or your loved one is working with.
There is an entire chapter on the amino acids and they are discussed throughout the book in the sections on gut health, gluten, blood sugar control, sugar cravings, self-medicating with alcohol and more.
The book doesn’t include product names (per the publisher’s request) so this blog, The Antianxiety Food Solution Amino Acid and Pyroluria Supplements, lists the amino acids that I use with my individual clients and those in my group programs.
You can find the amino acid products I use and a number of different lithium orotate products in my online Fullscript store.
If, after reading this blog and my book, you don’t feel comfortable figuring things out on your own (i.e. doing the symptoms questionnaire and respective amino acids trials), a good place to get help is the GABA QuickStart Program (if you have low GABA symptoms). This is a paid online/virtual group program where you get my guidance and community support. There are many moms in the program who are having much success with their kids.
If you are a practitioner, join us in The Balancing Neurotransmitters: the Fundamentals program. This is also a paid online/virtual program with an opportunity to interact with me and other practitioners who are also using the amino acids.
Do you resonate with any of the above and have you used lithium orotate with success?
Was the rollercoaster of emotions and fluctuating anxiety a hallmark for you before using lithium orotate?
If you’re a practitioner, do you use lithium orotate with your clients or patients?
If you have questions please share them here too.
My functional med doctor started me on lithium for all the reasons above but didn’t mention taking in combination with tryptophan. I feel better about this approach knowing you support it too.
Judy
It doesn’t need to be taken in combination with tryptophan and would only be used this way with someone with low serotonin symptoms.
I’d love to hear how much lithium orotate you are using and how it’s helping. Also, why it was recommended?
I definitely qualify with the aminos for low serotonin not working and just saw your blog for the first time.However, 5 mg of lithium orotate increases my appetite after trying it a week.Help!
Thanks
Hi! I could not find the low lithium questionnaire.
Connie
Please see the sections under the heading: Low lithium questionnaire
Do you do a lithium blood test along with the supplementation?
Panagiotis
I do not and nor does Dr. James Greenblatt (integrative psychiatrist) typically test when only using low dose lithium orotate. He also uses lithium orotate to help patients reduce prescription lithium carbonate and does test in these instances.
Do you use lithium orotate with clients and do you test?
Thanks a lot for your reply!
I have nit used it yet, that’s why I am gathering information about it 🙂
I tried lithium 5mg a couple of years ago for my mood disorder. I took a nap and woke up with my head spinning and throwing up for the rest of the day. I was later diagnosed with BPPV (benign paroxysmal positional vertigo). It eventually went away after a number of months. At a later point when I felt courageous enough to try it again, but in a micro dose (just a few crystals in my mouth), I still got BPPV, just not so bad I was throwing up. Now, I get vertigo and dizzy spells on and off chronically. No one can explain to me why this happened. Apparently, it’s a rare reaction. I’m tired of being dizzy all the time. I really wanted lithium to work. I answered yes to all of the questions on the questionnaire, so I clearly need it. But there is something going on on my brain that prevents me from being able to take it. Do you have any recommendations?
Becky
I’m sorry to hear. This feedback is new to me and I’d suspect a bad batch of lithium orotate (although I’ve not heard of this yet either).
Re the BPPV and dizziness I refer clients to a physical therapist who addresses the ears (Epley maneuver https://www.medicalnewstoday.com/articles/319171).
We also look into diet (gluten and oxalates are triggers) and herbal solutions. And of course, low GABA, low serotonin and high cortisol are often factors too since stress is a major trigger.
Best is having a complete functional work up done
the exact same thing happened to me. In me the vertigo was provoked by nystagmus and this was provoked by Lithium orotate.
Trudy is there a particular brand that you use or could recommend?
Is all this information the same for teen girls (14-15 yo)?
Car
I know Dr. James Greenblatt (integrative psychiatrist) uses low dose lithium orotate with teen girls with success and I have too. We base it on symptoms and response to the supplement.
Can you share what symptoms she has and what has helped/hasn’t helped?
How quickly do you find that the lithium orotate takes effect?
Lisa
Typically within a week to 2 weeks
Hi
I have heard lithium is very damaging for the kidneys when used in the long run. Is this the case for the low dose lithium as well?
Thanks so much
A Kumar
This is for prescription lithium.
Hi,
My 8yo daughter tested <0.1 on her lithium blood test and the normal reference range was 0.6 – 1.20. Do you have a suggested starting dose you recommend for children who may have a lithium deficiency? My daughter does also have low magnesium in which we supplement for and has been diagnosed ADHD but she is not taking any prescriptions. Thanks!
Tara
I don’t base recommendations off blood lithium levels but if there are low lithium symptoms we start low and monitor symptoms. For kids I start at half the typical starting dose of 5mg
Hi there! I have a 15 year old daughter with possible Bipolar. She has depression, anxiety and possibly an eating disorder. I’d like to know at what dosage I should start the lithium orotate, how to monitor and up if needed and should she take in combination with anything else? Its heartbreaking seeing her suffer so much. She had severe reactions to pharma meds and Im hoping this will help her
Nicole
I’d work with your integrative practitioner and consider 5mg as a starting dose. And of course also explore the amnino acids GABA, tryptophan, DPA and everything in my book “The Antianxiety Food Solution” – more here https://www.everywomanover29.com/blog/the-antianxiety-food-solution-by-trudy-scott/ Lesser known triggers of mood swings are low blood sugar swings, gluten issues, Hashimoto’s thyroiditis and hormone imbalances.
I have read not to take lithium orotate with ACE inhibitors, such as lisinopril, but from any research I find, lithium toxicity has only occurred with higher dose lithium. To me, 5 mg of lithium orotate would not be enough to cause toxicity with 10 mg lisinopril. Do you know of research with low dose orotate form and ACE inhibitors causing lithium toxicity? Thank you.
Joyce
I am not aware of any research with low dose lithium and ACE inhibitors. The research with prescription lithium (https://link.springer.com/article/10.1007/s40261-019-00768-7) does mention dehydration and checking blood lithium levels so for someone at high risk this could be an option to consider. With any supplements, when someone is on any prescription medication, their prescribing doctor needs to be informed and monitoring them.
Hi Trudy,
I have been taking 5 to 10 mg of Lithium Orotate on and off for 2 years at the recommendation of a Holistic MD for anxiety, depression and insomnia. I have read many articles since then that Lithium Orotate can negatively affect the thyroid. I was diagnosed with hypothyroidism 30 years ago-no Hashimotos- and have taken .075 mg Levothyroxine since then. I obviously get my thyroid levels checked every year but can you advise if there is cause for concern taking Lithium Orotate when taking thyroid replacement medication. I read that Lithium Orotate is stored in the thyroid and that it can affect the T4 to T3 conversion and can also possibly cause goiter.
I scored about 8 symptoms on your lithium orotate questionnaire including mood swings, internal and external restlessness, insomnia, suicidal thoughts, Jack of all trades/master of none. I am turning 69 next month and besides taking Gaba Calm, ashwagandha and lithium orotate, walking 3-5 miles outside every day has had the greatest impact on my mental health.
I trust your research on supplements you recommend in your book, (which is a great resource) blogs and podcasts and would like your feedback. I remember the first time I took 5 mg of Lithium Orotate that I noticed an almost immediate feeling of calm and well being.
Thank you for all you do. You ARE making a huge difference and are a blessing of hope for us suffering from issues that mainstream medicine can only offer another prescription drug with horrible side effects.
Katherine
Wonderful to hear that lithium orotate, GABA, ashwagandha and walking 3-5 miles outside every day has had such a great impact on your mental health.
We do know prescription lithium (lithium carbonate) has an adverse effect on the thyroid however I am not aware of any research on lithium orotate affecting the thyroid and would be interested to read the articles that do report this. Please do share a link or links.
This paper, Is there a role for lithium orotate in psychiatry? https://journals.sagepub.com/doi/10.1177/0004867418810185 does mention long-term safety and a potential concern with kidney/thyroid health
“3. There is no definitive evidence for the long-term safety of LO. It is, however, reassuring that there have been no reported cases of death or serious side effects in more than 40 years of LO use in the United States and Europe.
4. Nevertheless, the issues of safety would be paramount to consider especially in vulnerable populations, e.g., the elderly, people who have had previous kidney or thyroid problems and individuals who have ‘normal’ kidney and thyroid function but with an underlying pharmacogenetic susceptibility to lithium-induced renal or thyroid impairment.”
Very recently I had a nutritionist in my community post on a facebook lithium orotate post, sharing that she has seen thyroid antibodies increase in 2 clients taking lithium orotate. It’s not something I’ve seen (or hear Dr. James Greenblatt talk about/write about) but regular thyroid testing is a sensible approach to take.
I took lithium Orotate 5mg at night only for a few weeks. It was amazing at first, I felt calmer and my sleep improved greatly. But after about 2-3 weeks I started waking up and feeling very tired and in a fog all day, very unmotivated wanting to sleep or rest most of the time. So I decided to stopped even though it did make me feel better, and definitely improved my sleep. I’d love to know why it affected me this way as I would answer yes to most of the points on the questionnaire. thank you!
Tanya
In a case like this I’d suspect too much lithium orotate. It is available as 1mg too.
My 17 yr old daughter was recently diagnosed with Bipolar I anxiety, and mild autism. I was looking up natural options and found lithium orotate on your website. However, on the questionnaire, Bipolar II is listed as a condition. Is Lithium orotate not appropriate/strong enough to treat Bipolar I?
Thanks
A
Dr. Greenblatt is an integrative psychiatrist and recently shared he doesn’t use only lithium orotate with his bipolar patients, but often uses a combination with a lower dode of prescription lithium.
I encourage you to also look into other bipolar triggers – I have a number of blogs on the site https://www.everywomanover29.com/blog/?s=bipolar
My son has acute panic disorder that has set in over the past two months.
I have put him on GABA chew in bed in the am. Squirts GABA/ l-thiamine lipo under tongue througout his day as needed. Tryptophan at 2 pm and again at bedtime with mag threonate.
He is 23 and it’s like agoraphobia is setting in in past month. He works goes to college and fight panic attics his whole day now.
Should we add lithium? Start at the 2.5?
He has Lyme and Babesia. Had Covid, took ivermectin and zpack with no herx.
I am getting very concerned as this is so new. Could it be from post Covid and Lyme?
If so should we be going with a different approach. We have cut folic acid. He is MTHFR/677
Cut carbs and dairy.
It’s starting to cause anxiety in me with worry.
Thank you so much!
I think I read you are not taking new patients. If not do you have any Ny area Dr recommendations.
Vee
I’m sorry to hear about your son. When GABA and tryptophan are helping, even if it’s only a little bit, we contonue to increase the dose to find the ideal dose. We do this before adding something new like lithium orotate. That said, if there are ups and downs it does make the amino acids more effective.
I’m not sure if you landed on this lithium blog after having read today’s blog – “I’m In An Abusive Relationship That I Will Never Walk Away From”: tryptophan, a gluten-free diet, lithium and other nutritional solutions https://www.everywomanover29.com/blog/im-in-an-abusive-relationship-that-i-will-never-walk-away-from-tryptophan-a-gluten-free-diet-lithium-and-other-nutritional-solutions/ If yes, I updated the PANS/PANDAS bullet as follows: typically the clue it may be PANDAS/PANS is sudden onset of symptoms, although it’s not the case in all instances.
Covid can increase anxiety in many instances too. And so can Lyme and coinfections.
When you are new to using amino acids my book The Antianxiety Food Solution is a good resource for the amino acids, other nutrients, pyroluria, gut health and all the dietary factors too – https://www.everywomanover29.com/blog/the-antianxiety-food-solution-by-trudy-scott/ I have clients cut all gluten too and caffeine.
If you do find you need guidance and support – GABA Quickstart program https://www.anxietynutritioninstitute.com/gabaquickstart/ You get specific feedback because I gather a mini health history.
My 23 yr old son….
I forgot to add that his zinc is at 80 and his copper if only 5. I know that is extremely low copper. Could that be a contributing factor?
Ver
Blood testing of zinc and copper is notoriously inaccurate.
Trudy you doing amazing work! Your article & commentaries are spot on. I wish I learned more about the GABA/lithium orotate connection a few years earlier, I’m a nurse, but not the greatest patient haha- but all is well & I’ve been on a good plan now. My personal hx started as hormonal imbalance vegan diet, no mental health/Rx concerns, e.g., long heavy periods, obstructed gallbladder, & eventual uterine fibroids the size of oranges.
S/p gallbladder removed @42, then @46, hysterectomy (one ovary spared) & then menopause hits me like a brick wall a year in a half later. Holy moly! Five yrs later, I’m sx free for almost 1 yr now, on a carnivore diet again, daily Premarin 0.625 tab for severe hot flashes & lithium orotate, Mg+ orotate & astaxanthin helps with moods, joint pain & everything else. I take a few other supplements but they’re more supportive as co factors for those 4 just listed. But I’m so fascinated learning how invaluable a salt like lithium orotate affects gaba & our cognition, hormones, muscle & neuro so completely! I can’t wait to read your book, thanks so much!
Jeri
Glad you’re doing better and that you’ve figured out how supportive lithium orotate is for you. Enjoy the book!
Hi Trudy, Do you have a recommended brand of Lithium Orotate? Thank you.
Pat
Pure Encapsulations is good and has 1mg and 5mg bottles
Hello Trudy. I fit in many of the above mentioned symptoms and I am also hypothryoid currently on liothyronine. I did notice that one of the symptoms you mentioned was hyperthyroidism and it made me wonder . In my current health and use of thyroid meds I have been having problems with raising my cortisol to appropriate levels. I suspect it has been low from young age and my body has adjusted somehow to the low levels. In addition, my work as a nurse is very stressful and I suspect that has contributed largely to the HPA axis dysfunction, which in turn is bringing on the low cortisol and hypothyroid issue. I was pointed to litium use and I was excited to read in a clinical article that it helps the HPA axis. However I only found one article on medpub and wondered if in your experience you have seen people to have HPA axis assisted by lithium orotate? Thank you so much for your insight.