Pass the salt. Tuesday, Oct. 12, 2010.

“I like it, I’m not gonna crack.” –Nirvana, “Lithium”

Does it sound a little Brave New World-y to you? Bioethicist Jacob M. Appel wants to put Lithium Carbonate in your drinking water.

Actually, Lithium Carbonate is an amazing little substance. It’s actually a salt, not too far removed from the salt on your dinner table, and it’s used to process metal oxide – but you probably know it best in its psychiatric applications, where it is the number one treatment for bipolar disorder.

Lithium’s way different from other medications used in psychiatry. It has an amazingly long history, having been first discovered effective against mania in 1871 (you read that right). In 1886, it was discovered to be effective against depression. It took a century for the FDA to approve it, though, and in the meantime, people were given exceedingly high doses that occasionally killed them. Oops.

But once doctors learned to administer it properly – and to test patients’ blood periodically to make sure there was no toxicity – they discovered something about Lithium that makes it different from every other psychiatric medication: it seems to have an anti-suicide effect.

It’s not just about relieving manic/depressive symptoms; meds like Lamictal and Zyprexa do that too. But Lithium is extra special. In study after study, patients taking Lithium are less likely to kill themselves than those on other meds. One study, for example, at the University of Cagliari in Sardinia, found that suicidal patients were eight times less likely to commit suicide if they took lithium – and that the pattern more than reversed itself if they stopped taking their meds.

But the best-known evidence is the data collected from 27 Texas counties between 1978 and 1987, which demonstrated that the incidence of suicide (as well as homicide and rape) were significantly lower in areas with naturally-occurring Lithium Carbonate in the water supply. Last year, there was a similar finding in Oita, Japan. The amount of Lithium in the water was quite small – much, much less than one would get taking tablets; the stabilizing effects were seen not only in people who are diagnosed bipolar, but among the general public; and no adverse health effects were reported.

So, says Appel, maybe we should put Lithium Carbonate in everybody’s drinking water, just like we add fluorine to prevent cavities.

Whoa! Whoa! Whoa! People were already freaking out about the fluoride. And don’t we keep reading about the dangers of traces of pharmaceuticals that are making their way into our water supply? On the other hand, fewer suicides, rapes and homicides might be a good thing…

I took Lithium for many years. I stopped taking it for several, and bad things happened. I’m back on it, and so far, so good. I don’t mind the blood tests – although every time I get one, I’m reminded that this salt is a drug – and a powerful one at that.

Somewhere in my bookshelf, I have “1984,” “Brave New World” and “This Perfect Day.” Let me read those again, and I’ll get back to you on the question of whether I think that my drug belongs in your drinking water. Okay?