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Open Access Highly Accessed Review

Nutritional therapies for mental disorders

Shaheen E Lakhan* and Karen F Vieira

Nutrition Journal 2008, 7:2  doi:10.1186/1475-2891-7-2

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Lithium is no nutrient, and orotate may not be so much better

Ben C   (2008-10-22 10:18)  Independent email

Lithium is not a part of the Dietary Reference Intakes, and so its classification as a nutrient in this paper is puzzling. I'm assuming that the authors do not consider it a nutrient, but an explicit qualification on that would have been nice. Similarly, St. John's Wort doesn't seem to be a nutrient.

The bigger problem is that lithium orotate may be not be so much more helpful, and Lakhan and Veira present an unfortunately one-sided view of the literature. I haven't looked at the papers they cite because I can't afford it, but other studies don't show conclusive evidence that lithium orotate crosses the blood-brain barrier more easily. Kling et al in 1978[1] found it increased uptake to the brain in rats when injected, but in 1976 Smith concluded that it didn't increase uptake to the brain.[2] In 1979 Smith et al tested again, and this time he found different results. He found that lithium orotate increased serum lithium concentrations higher, but was also deposited in the heart and kidney. He did not comment on the brain concentrations in his abstract, possibly because he did not want to admit that Kling was right (I only read the abstract).[3]

Lithium orotate probably deserves more attention and comparison with lithium carbonate than it gets. Smith seems inclined to look for the negative, and his 1976 finding was suspiciously anomalous. Nevertheless, it seems that lithium orotate does not only go to the brain. Even if it does go to the brain, it makes one wonder why the negative symptoms of lithium carbonate do not apply to lithium orotate. It seems as if these symptoms would be largely dependent upon the brain concentrations of lithium.

Thank you for the interesting paper, but please try to present a neutral view of the facts in the future. In many cases a more focused approach is better. I am hopeful for the future of nutrients in treating mental illness. Note that there are critical reviews of many of the substances discussed here. For example, in January 2008 the Current opinion in psychiatry concluded that the "evidence base for the efficacy of the majority of complementary and alternative interventions used to treat anxiety and depression remains poor".[4] In April 2008 a Cochrane review could only include 5 studies on omega-3 fatty acids and bipolar disorder, and of those only 1 provided data for analysis.[5]

Possibly these reviews are actively looking for the negative, and perhaps ignoring legitimate literature. In that case they need to be engaged, not ignored. To be fair, both of these aforementioned reviews were published around or after your review was published. I noticed that one of your peer reviewers mentioned these concerns, but somehow that reviewer dropped out of the picture.

Regards,

Ben Creasy

Competing interests

None.

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