Lithium orotate over the counter for bipolar illness?

by | Aug 16, 2023 | Curbside Consults

Q: I have a question about Lithium Orotate 10 mg or other low dose. I have a few patients who cannot accept their manic depressive diagnosis but they would accept Lithium Orotate OTC low dose. I suggested it to one after doing the usual labs and EKG. She said it is helping her and she continues to refuse Lithium Carb as well as Bipolar diagnosis. I do not push either as she is slowly questioning it herself. Is Lithium orotate 10 mg ok if a patient refuses carbonate?

PL: Lithium orotate 5 mg/d is equivalent to lithium carbonate 25 mg/d. Lithium orotate is available over the counter in the US in up to 20 mg pills, which would be equivalent to 100 mg/d of lithium carbonate. Some people will respond to lithium at low doses equivalent to about 300 mg/d of lithium carbonate or even less, which is 3 lithium orotate 20 mg pills. So it is feasible to get near clinically effective doses for some cases of mood illness with enough over the counter lithium orotate. Further, there is one randomized study that showed mood benefits with lithium at doses of 5 mg/d lithium orotate equivalents versus placebo. Hence there can be mood benefits with over the counter lithium orotate, and if someone refuses higher doses of lithium carbonate, it is reasonable to try lithium orotate. In my view, any amount of lithium is better than none. That said, in many people with moderate to severe bipolar illness, higher doses can only be achieved with prescription lithium. For what it’s worth, on Amazon reviews, some people claim that their full blown bipolar illness has responded to lithium orotate.