Lithium In Drinking Water Research Articles

The Relationship between Lithium Concentration in Drinking Water and Suicide Mortality: A Systematic Review

Title: The relationship between lithium concentration in drinking water and suicide mortality rate: A systematic review. Background: Suicide is one of the leading causes of death worldwide and is influenced by multiple factors. Recently, several studies have shown that lithium in drinking water is useful for reducing the suicide mortality rate. However, it is still uncertain whether lithium intake from drinking water can achieve an anti-suicidal effect. We performed a systematic review to determine the relationship between lithium in drinking water and suicide mortality rate. Methods and Findings: We reviewed articles related to the lithium concentration in drinking water and suicide mortality rate in various geographical areas between 1990 and 2020. Of 17 articles in our systematic review, 13 reported that lithium in drinking water was significantly negatively associated with standardized mortality ratio (SMR), while 4 studies did not show any associations. On the other hand, others with meta-analysis indicated that there was a negative association between lithium concentration in drinking water and suicide mortality rate. Conclusion: Most of the studies in this review revealed that lithium concentration in drinking water was inversely related to the expected suicide mortality rate in these studies. We reviewed these articles and maintain that the balance of lithium concentration in drinking water and SMR is important in determining whether lithium in drinking water affects suicide mortality rate. If the lithium concentration is stable over the entire study region, or suicide mortality rate is very low, an association between the lithium concentration in drinking water and suicide mortality rate could not be detected even with high lithium concentrations. Therefore, it may be difficult to evaluate the effect of lithium in drinking water on suicide. Further studies are needed to determine the factors related to suicide and lithium intake from sources other than drinking water to assess the relationship between tap water lithium concentration and suicide mortality rate.

Lithium in Public Drinking Water and Suicide Mortality in Portugal: Initial Approach.

Lithium can be found naturally in drinking water. There is some evidence that natural levels of lithium in drinking water may have a protective effect on suicide mortality. The aim of this study is to evaluate if higher natural concentrations of lithium in public drinking water are associated with lower local rates of suicide in Portugal. Suicide standardized mortality ratios at 54 Portuguese municipalities within the 6-year period from 2011 to 2016 was correlated with lithium concentrations in public drinking water and socioeconomic factors using Pearson's correlation coefficients (r) with one-tailed tests. Multivariate regression models were adjusted for well-known socioeconomic factors known to influence suicide mortality in Portugal (population density, average income per capita, unemployment rates and proportion of Roman Catholics). The average lithium level, as evidenced by raw values for 54 municipalities, was 10.88 μg/L (standard deviation = 27.18). There was no statistically significant correlation between lithium levels and suicide standardized mortality ratio (r = 0.001, p-value = 0.996). There was a statistically significant higher suicide standardized mortality ratio for males (p-value = 0.000). When analyzed separately for both sexes, no statistically significant correlation between suicide standardized mortality ratio and lithium levels was found (male r = 0.024, p-value = 0.862; female r = 0.000, p-value = 0.999). No association between suicide standardized mortality ratio and socioeconomic factors was found: population density (r = -0.144, p-value = 0.300), average income per capita (r = -0.112, p-value = 0.418), unemployment rates (r = -0.001, p-value = 0.994), and proportion of Roman Catholics (r =- 0.150, p-value = 0.278). Unlike most international studies regarding natural lithium levels and suicide risk, no inverse relation was found in Portugal. Factors such as the country's low suicide rate, confunding suicide risk variables, and unaccounted lithium intake might have influenced these findings. No association between lithium in public drinking water and suicide rates was found in Portugal.

Prophylactic mood stabilization: What is the evidence for lithium exposure in drinking water?

Large-scale population registers and databases have great potential for use in hypothesis-generating epidemiological research. Utilising such data, cross-sectional and ecological studies are relatively inexpensive and time-efficient observational studies that can identify correlations between exposures and outcomes. In the field of lithium research, this has generated interest in exploring the effect of exposure to micro-levels of lithium levels in drinking water. The studies carried out so far have predominantly examined associations between lithium exposure and rates of suicide and violence and only a paucity looked at associations between lithium exposure and mood. This is interesting considering that, for therapeutic levels of lithium in bipolar disorder, the evidence first supported its efficacy on mood and it only recently demonstrated an independent effect of lithium on suicidality, which may be specific and not secondary to the improvement of affective symptoms.1 Ecological studies have reported associations between geographical differences in lithium levels in the drinking supply and rates of suicide, suggesting that exposure to microlevels of lithium may have a prophylactic effect.2 One important limitation of such population studies, which rely on anonymised datasets, is their inability to link individual exposures to outcomes. This is overcome when all national datasets and registers use a common identifier, as is done in Denmark through the use of unique personal identification numbers, thereby allowing exposures to be linked to outcomes at an individual level. Kessing et al. have utilised this added strength of Danish population datasets to explore the link between exposure to microlevels of lithium in drinking water and incidence of bipolar disorder.3 The study estimates individual average lithium exposure by combining longitudinal data on areas of residence with data from drinking water lithium levels in the various municipalities. Comparing average lithium exposure in individuals with a hospital diagnosis of bipolar disorder to matched controls over a 13 year period, it found no association between higher long-term lithium exposure and reduced incidence of bipolar disorder.

Lithium in drinking water and the incidence of bipolar disorder: A nation-wide population-based study.

Animal data suggest that subtherapeutic doses, including micro doses, of lithium may influence mood, and lithium levels in drinking water have been found to correlate with the rate of suicide. It has never been investigated whether consumption of lithium may prevent the development of bipolar disorder (primary prophylaxis). In a nation-wide population-based study, we investigated whether long-term exposure to micro levels of lithium in drinking water correlates with the incidence of bipolar disorder in the general population, hypothesizing an inverse association in which higher long-term lithium exposure is associated with lower incidences of bipolar disorder. We included longitudinal individual geographical data on municipality of residence, data from drinking water lithium measurements and time-specific data from all cases with a hospital contact with a diagnosis of mania/bipolar disorder from 1995 to 2013 (N=14820) and 10 age- and gender-matched controls from the Danish population (N= 140311). Average drinking water lithium exposure was estimated for all study individuals. The median of the average lithium exposure did not differ between cases with a diagnosis of mania/bipolar disorder (12.7μg/L; interquartile range [IQR]: 7.9-15.5 μg/L) and controls (12.5μg/L; IQR: 7.6-15.7 μg/L; P=.2). Further, the incidence rate ratio of mania/bipolar disorder did not decrease with higher long-term lithium exposure, overall, or within age categories (0-40, 41-60 and 61-100years of age). Higher long-term lithium exposure from drinking water was not associated with a lower incidence of bipolar disorder. The association should be investigated in areas with higher lithium levels than in Denmark.

Early-life exposure to lithium in drinking water and infant thyroid function.

Introduction: Elevated lithium exposure via drinking water seems to impair thyroid function in pregnant women, but potential impact on the infants is unknown. This study aimed at elucidating if elevated early-life lithium exposure may affect the infant thyroid function. Methods: In a population-based mother-child cohort recruited at early pregnancy in the Argentinean Andes, where drinking water lithium vary 5-1,660μg/L, we followed up the infants (n=110) up to 6 months of age. We assessed early-life lithium exposure by the concentrations in maternal blood (average concentrations during pregnancy), cord blood and infant urine at 0-3 and 3-6 months of age, measured by inductively coupled plasma mass spectrometry. Markers of infant thyroid function included thyrotropin (TSH), free/total thyroxine (fT4/T4) and free/total triiodothyronine (fT3/T3) in serum at 3-6 months of age. Results: The lithium concentration in cord blood (CB-Li), median 51μg/L (range 9.5-156), was higher than in maternal blood (B-Li), 27μ...

Environmental exposure to lithium during pregnancy and fetal size: A longitudinal study in the Argentinean Andes

BackgroundLithium, used for treating bipolar disease, crosses freely the placenta and is classified as teratogenic. It is unclear to what extent environmental lithium exposure may affect fetal growth and development. ObjectivesTo elucidate potential effects of lithium exposure through drinking water during pregnancy on fetal size. MethodsWe developed a prospective population-based mother–child cohort (N=194) in an area with highly varying drinking water lithium concentrations (5-1600μg/L) in northern Argentinean Andes. Blood and urinary lithium concentrations (sampled repeatedly during pregnancy) were measured using inductively coupled plasma mass spectrometry. We measured fetal size by ultrasound in second and third trimesters, and weight, length and head circumference at birth. Multivariable models were used to examine associations between lithium exposure (continuous and in tertiles) and fetal size measures. ResultsLithium in maternal blood (median 25; range 1.9–145μg/L) and urine (1645; 105–4600μg/L) was inversely associated (apparently linearly) with all fetal measures (body, head and femur) in the second trimester, and with birth length (β −0.53cm per 25μg/L increase in blood lithium, 95%CI −1.0; −0.052). An increase of 100μg/L in blood was associated with 2cm shorter newborns (about one standard deviation). ConclusionsLithium exposure through drinking water was associated with impaired fetal size and this seemed to be initiated in early gestation. Further studies are warranted to confirm causality and to understand the mechanisms. If confirmed, these findings have public health relevance and emphasize the need for more data on lithium concentrations in drinking water, including bottled water.

Low-dose lithium uptake promotes longevity in humans and metazoans

PurposeLithium is a nutritionally essential trace element predominantly contained in vegetables, plant-derived foods, and drinking water. Environmental lithium exposure and concurrent nutritional intake vary considerably in different regions. We here have analyzed the possibility that low-dose lithium exposure may affect mortality in both metazoans and mammals.MethodsBased on a large Japanese observational cohort, we have used weighted regression analysis to identify putative effects of tap water-derived lithium uptake on overall mortality. Independently, we have exposed Caenorhabditis elegans, a small roundworm commonly used for anti-aging studies, to comparable concentrations of lithium, and have quantified mortality during this intervention.ResultsIn humans, we find here an inverse correlation between drinking water lithium concentrations and all-cause mortality in 18 neighboring Japanese municipalities with a total of 1,206,174 individuals (β = −0.661, p = 0.003). Consistently, we find that exposure to a comparably low concentration of lithium chloride extends life span of C. elegans (p = 0.047).ConclusionsTaken together, these findings indicate that long-term low-dose exposure to lithium may exert anti-aging capabilities and unambiguously decreases mortality in evolutionary distinct species.

Lithium in drinking water and the incidences of crimes, suicides, and arrests related to drug addictions

Using data for 27 Texas counties from 1978-1987, it is shown that the incidence rates of suicide, homicide, and rape are significantly higher in counties whose drinking water supplies contain little or no lithium than in counties with water lithium levels ranging from 70-170 micrograms/L; the differences remain statistically significant (p less than 0.01) after corrections for population density. The corresponding associations with the incidence rates of robbery, burglary, and theft were statistically significant with p less than 0.05. These results suggest that lithium has moderating effects on suicidal and violent criminal behavior at levels that may be encountered in municipal water supplies. Comparisons of drinking water lithium levels, in the respective Texas counties, with the incidences of arrests for possession of opium, cocaine, and their derivatives (morphine, heroin, and codeine) from 1981-1986 also produced statistically significant inverse associations, whereas no significant or consistent associations were observed with the reported arrest rates for possession of marijuana, driving under the influence of alcohol, and drunkenness. These results suggest that lithium at low dosage levels has a generally beneficial effect on human behavior, which may be associated with the functions of lithium as a nutritionally-essential trace element. Subject to confirmation by controlled experiments with high-risk populations, increasing the human lithium intakes by supplementation, or the lithiation of drinking water is suggested as a possible means of crime, suicide, and drug-dependency reduction at the individual and community level.

Drinking water lithium levels fail to predict for the incidences of acute or chronic granulocytic leukemia.

Frenkel and Herbert (1974) commented upon the inverse relationship between drinking water lithium ion (Li+) content and the incidences of acute granulocytic leukemia (AML) in the Dallas-Ft. Worth standard metropolitan statistical area (SMSA) and in El Paso, Texas. They also noted a similar incidence of chronic granulocytic leukemia (CML) in the two areas, suggesting no relationship to drinking water Li concentrations. We have further investigated these relationships by correlating the drinking water Li+ concentrations with the incidence rates of AML and CML in 19 American cities, SMSAs, or states. For both AML and CML, we have determined no significant correlation (p > 0.10) between drinking water Li+ content and the incidence data.KeywordsIncidence DataPublic Water SupplyGranulocytic LeukemiaLithium LevelStandard Metropolitan Statistical AreaThese keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.