Below are many references to the fact
that lithium is helpful for aggression, irritability and violent behavior. The
concern over using the pharmaceutical drug lithium is always one of detrimental side effects and the possibility of lithium
toxicity. However, the bioavailibility of lithium orotate allows very small
amounts to be used effectively. The same positive results may be achieved without any of the negative effects
of the drug forms of lithium.
The National Institute of Mental Health
(NIMH) states that “Lithium is the most promising agent for the treatment of aggression in children and adolescents."
In The Biology of Aggression,
Vol 3, Spring 1999, it states that “Lithium is impressive in treating antisocial, aggressive and assaultive behavior”
(citing Bloom and Kupfer, 1994; Sheard et al., 1976; Tupin et al., 1973).
(continuing) "Michael Sheard., a
biologist at Yale, had been working with the anti-manic agent lithium carbonate. In a four-month study, Sheard gave lithium
or placebo (a sugar pill) to approximately 40 prison inmates. The results were remarkable. While lithium had no effect on
nonviolent behavior (stealing, lying), it appeared to fully suppress serious assault in inmates as observed and documented
by prison guards.
Even more important was the observation that impulsive aggression returned to previous levels in
the lithium-treated subjects after they were switched to the placebo condition."
In research supported by the National
Institute of Mental Health, Dr. Paul H. Soloff concluded that,
of impulsive, criminal adults and of delinquent adolescents demonstrate a strong effect for lithium against impulsive-aggressive
symptoms……. The double-blind studies and additional case reports (e.g., Shader, Jackson, & Dodes, 1974) support
an 'A' recommendation for the use of lithium for this indication.” (Dr. Paul H. Soloff, M.D., March 1997. Dr. Soloff is professor
of psychiatry, Department of Psychiatry, University of Pittsburgh School of Medicine. )
of the American Medical Association
of General Psychiatry
57 No. 7, July 2000
Double-Blind Placebo-Controlled Study of Lithium in Hospitalized Aggressive Children and Adolescents with Conduct Disorder
P. Malone, MD; Mary Anne Delaney, MD; James F. Luebbert, MD; Jacqueline Cater, PhD; Magda Campbell, MD
Background: A subgroup of children and adolescents with conduct disorder are
characterized by severe and persistent aggression. Although there is no agreed on treatment for such aggression, lithium carbonate
has shown promise in some studies involving children. Our study was designed to critically assess the efficacy of lithium
in the treatment of aggression in children and adolescents using a measure specific for aggression.
Methods: Subjects were inpatients with conduct disorder hospitalized because
of severe and chronic aggression. A parallel-groups design was used in this double-blind, placebo-controlled trial with randomization
to lithium or placebo. Only those who met the aggression criterion during the 2-week placebo-baseline period were randomized
to 4 weeks of treatment. Outcome measures included Clinical Global Impressions, the Global Clinical Judgments(Consensus) Scale,
and the Overt Aggression Scale.
Results Eighty-six inpatients enrolled in the study; 40(33 male and 7 female;
median age, 12.5 years) entered and completed the treatment phase. Lithium was statistically and clinically superior to placebo.
Sixteen of 20 subjects in the lithium group were responders on the Consensus ratings vs. 6 of 20 in the placebo group (P=.004). Ratings on the Overt Aggression Scale decreased significantly for the
lithium group vs. the placebo group (P=.04).More than half of the subjects
in the lithium group experienced nausea, vomiting, and urinary frequency.
note** These are side effects of the drug form of lithium carbonate. Lithium orotate does not cause these or any other side
Conclusions: Lithium is a safe and effective short-term treatment for aggression
in inpatients with conduct disorder, although its use is associated with adverse effects (**Website note** referring to the
'adverse effects' of lithium carbonate which lithium orotate would not have.)
Lithium in the treatment of aggression in mentally
M Craft, IA Ismail, D Krishnamurti, J Mathews, A Regan, RV Seth and PM North Bryn-y-Neuadd
In a double-blind trial lasting 4 months in 42 mentally handicapped patients, the effect
of lithium on aggression was assessed in comparison with placebo. In the lithium-treated group, 73% of patients showed a reduction
in aggression during treatment. There were significant differences in mean weekly aggression scores and in the frequency of
aggressive episodes between the lithium and placebo groups. Side-effects were noted in 36% of the lithium group (and 20% of
the placebo group), but were mainly transitory. There were no episodes of toxicity, and no patients had to be withdrawn from
the trial. Lithium appears to be worth a 2-month trial in such patients, where repeated aggression has not been relieved by
more appropriate placement, occupation or company.
Lithium for irritability in post-traumatic stress disorder.
Forster PL, Schoenfeld FB, Marmar CR, Lang AJ.
University of California, San Francisco.
is often a problem for patients with Post-Traumatic Stress Disorder (PTSD). We describe two cases that illustrate the use
of lithium in the treatment of veterans with PTSD who complained of serious problems with irritability or angry outbursts.
These cases are discussed in the context of evidence that lithium may be useful in other patients with disorders of impulse
control. The evidence linking disorders of anger and impulse control to a dysregulation in neurotransmitter
regulation, particularly in serotonergic pathways, supports a psychopharmacologic approach to treatment.
These findings should lead to further study of the role of lithium in the treatment of this symptom complex in patients with
Vol. 2, No. 2 / February 2003
Benefits of low-dose lithium
In “Rediscovering the art of lithium therapy”
(Current Psychiatry, December 2002), James W. Jefferson, MD, remarked that
“Many patients on maintenance therapy do well at (lithium blood) levels between 0.6 and 0.8 mEq/L,
and some prosper at even lower levels.”
Extremely low dosages of lithium may help well-functioning
individuals who tend to be impatient or easily irritated. These persons are not impulse-ridden, are neither aggressive nor
manic, and may not act out in an obvious way. They simply fume when waiting in a long line, or when someone cuts in front
of them in traffic. They may complain excessively, and their blood pressure might be significantly elevated when agitated.
The intensity and duration of their anxiety over mundane tribulations are the identifying characteristics. Such individuals
might be classified as “bipolar III;” their depressive episodes are all but indistinguishable from the low end
of the normal mood spectrum.
Hyperirritability has historically been included
in diagnoses such as atypical depression or dysthymic disorder and may respond to antidepressants.
This symptom, however, could also indicate a mild bipolar variant that is better treated with low-dose lithium. Starting such
patients on lithium, 300 mg/d or even 150 mg qd, can bring significant relief, usually without side
effects. In extremely low dosages, a therapeutic response may be obtained even though the blood level is well below 0.5 mEq/L. Patients who respond to low-dose lithium therapy typically report that they hardly notice the minor
stressors that once angered them.
Other classes of drugs, such as MAO inhibitors,
have also undeservedly fallen from grace as has lithium. Newer drugs should not replace older, effective ones without a clear
rationale. Too often, psychiatric patients relapse while taking a newer medication; they stop taking the older agent “because
my doctor said a newer, better one is out now."
Lorraine S. Roth, MD
Boston VA Outpatient Clinic
Dr. Jefferson responds:
Lithium does appear to be beneficial in
aggressive impulsivity, although to my knowledge it has not been studied formally at the low dosages that Dr. Roth has found
to be effective. Kitchner and Greenstein1 did describe five Vietnam veterans with posttraumatic
stress disorder whose anger, insomnia, irritability, and anxiety responded to 300 to 600 mg/d of lithium carbonate.
the individuals Dr. Roth describes do not fit a conventional bipolar profile, they might have a place within the ever-expanding
softer bipolar spectrum (well beyond the drug-induced manias and hypomanias of bipolar III). Perhaps her intriguing observation
can help the road-ragers who roam the freeways of Los Angeles and other large cities.
James W. Jefferson, MD