Lithium in your drinking water

Below is an article in today's New York Times Opinion page. It discusses the microscopic amount of lithium in normal drinking water, and the rates of suicide and depression that vary with the amounts in the water by area. In my practice, lithium is a great adjunctive or alternative medication but difficult to take because of the frequent monitoring of tremors and blood levels, thyroid and kidney functioning, risk of fatality in overdose (which can introduce a dilemma in an already severely depressed person), and risk of fetal abnormalities when taken by a pregnant woman. Yet the results are often very effective, which is why we learned in medical school that lithium, problematic as it may be, is still the "gold standard" in treating bipolar disorder.  Nowadays we attempt to treat bipolar disorder with atypical antipsychotics first because of the above problems, but lithium is never far from a psychiatrist's mind if those are not effective.

But it introduces an interesting question: people often joke that America needs to put Prozac (and statins, an group of cholesterol-lowering drugs) in the drinking water. Those are manmade medications, and intuitively seems like shouldn't be put into everyone's system. But what about a naturally occurring element like calcium (added to milk and orange juice) or iodine (found in salt)? Were we supposed to have more lithium in our body all along, being dependent on nature to provide, and the high rates of depression and bipolar disorder are because we are deprived of a natural, necessary element? How could we know what that level is? Would there be harm in adding a little lithium? A fascinating article that opens lots of avenues for discussion. I welcome your thoughts.

Should We All Take a Little Bit of Lithium?