Inside Health

Lithium is a natural remedy for bipolar disorder, writes Dr Catherine Calderwood

You might be surprised to know how many medicines we use on a regular basis come from natural sources. Whether you’re reaching for an aspirin to combat a headache (bark of the willow tree), digoxin for heart failure (purple foxglove) or penicillin for a bacterial infection (mould), our environment provides access to a whole host of potential medications just waiting to be put to use. Most of them have been around for a long time.

But do you know much about lithium? It’s a natural compound too, a salt that is present in very small amounts in tap water and food. We put sodium chloride on our chips all the time, even when we shouldn’t, but we rarely consider there are other salts that could help us. Intriguing international research has shown that places with different natural lithium amounts in the drinking water may have different levels of suicide and dementia in their populations, an association which merits further research. What we already know is that, when used as a medication, lithium works really well for those with bipolar disorder.

Research tells us that when we compare lithium with other medicines for bipolar disorder, it better controls the distressing and extreme mood swings experienced by those with the condition. It’s also less likely to cause significant weight gain and appears to be more effective at preventing suicide – this is especially important as bipolar disorder has one of the highest suicide rates of any mental health condition. You might think then, as I do, that this sounds like the ideal drug to help people with bipolar disorder manage their condition.

However, despite these advantages, we know that we don’t use lithium enough for bipolar patients in Scotland. Research by Professor Daniel Smith and his team in Glasgow University, in partnership with NHS Greater Glasgow and Clyde, shows a decline in its use in recent years, with only about one in five people with bipolar disorder receiving it.

This may be in part because lithium needs to be prescribed at the right amount. Too little and it doesn’t work, too much and side-effects can occur. Being a salt, blood tests are also needed to make sure it is not harming your kidneys or heart and, like many medicines, careful management is needed in pregnancy. As a result, patients and doctors are aware of the potential dangers and might shy away from using it when it is perfectly safe with proper monitoring and more effective than the alternatives. People might be scared, but they don’t need to be and this applies to getting help for all mental health problems.

It’s really important that people get the treatment they need to get them better and keep them well. I have described my aim for Realistic Medicine – I want people in Scotland to be at the centre of their own healthcare decisions and be properly informed so they can choose treatments that are right for them. For many people with bipolar disorder, that could be lithium.

That’s why I’m pleased today to be visiting the Eastwood Health and Care Centre in Glasgow to promote new National Lithium Guidance, produced by the Scottish Government, to support the use of lithium for bipolar disorder. Our guidance gives clear advice to doctors on how often to monitor people taking lithium and what tests to do, providing reassurance which they can pass onto patients. I hope it will help support doctors and patients to better use what is, after all, a natural remedy.

Dr Catherine Calderwood is Scotland’s Chief Medical Officer