Lithium for Fibromyalgia?

Discussion in 'Fibromyalgia Main Forum' started by KerryK, Jun 24, 2010.

  1. KerryK

    KerryK Member

    I wonder if anyone with FMS here has been on lithium and had benefit for their symptoms? I read that Lithium, among other things, stabilizes peripheral nerve function. Plus, one of its listed side effects is skin anesthesia. Small studies have shown great benefit, though published evidence seems lacking. It can be dangerous, however.

  2. u&iraok

    u&iraok New Member

    Are you talking about the mineral? I didn't take the drug lithium, but the mineral lithium orotate and had great success. I was extremely low in it and once I took it my constant low-level depression was gone.
  3. gapsych

    gapsych New Member

    Could you cite the studies? I can't find them.

    Yes, lithium can be very dangerous. You need to have frequent bloodtest to make sure you are on an appropriate dose. As far as bipolar goes there are a lot of medications without the side effects nor a need for a bloodtest.

  4. KerryK

    KerryK Member

    First, from an anethesiology journal "Anesthesia & Analgesia":

    Lithium for Fibromyalgia
    To the Editor:
    I feel ethically obligated to write this letter. I am an anesthesiologist
    and have been disabled by fibromyalgia for over 10 years. During
    this time, my husband, John Lewis, also an anesthesiologist, and I
    have been studying the disease.
    After excess activity, a major component of my pain can become
    debilitating, affecting all aspects of life and preventing sleep. This
    pain is not responsive to opioids, NSAIDs, or gabapentin. However,
    a dose of 300 mg of lithium carbonate will decrease the pain by
    70–80% within 40 minutes. The effect lasts 4–5 hours. It is dramatic.
    It is reproducible. There is precedent for its use (1,2).
    Dr. Lewis and I believe that fibromyalgia may be related to a
    calcium-parathyroid axis dysfunction. Lithium causes a brief rise in
    parathyroid hormone. Perhaps this is the reason for the drug’s
    efficacy (3).
    Lithium has a long history of safe use. It is inexpensive and
    readily available. Side effects are usually well tolerated. If large
    doses are needed, blood levels should be monitored. It is worth a
    Toinette Fontrier, MD
    Department of Anesthesiology
    Wake Forest University Medical Center
    Winston-Salem, NC
    1. Tyber MA. Lithium carbonate augmentation therapy in fibromyalgia. Can Med Assoc
    J 1990;143:902–4.
    2. Teasell RW. Lithium therapy for fibromyalgia [letter]. Can Med Assoc J 1991;144:122–3.
    3. Lewis JM, Fontrier T. Lithium and fibromyalgia. J Musculoskeletal Pain 2003;11:69–70.


    Li'thi'uim carbonate augmientation therapy
    in fibromyalgia
    Murray A. Tyber, MD
    F ibromyalgia (fibrositis) is a disorder of unknown
    cause. The typical features are multiple
    tender points, musculoskeletal pain and stiffness,
    and unrestorative sleep. The formulation by
    Smythe and Moldofsky' of acceptable diagnostic
    criteria and the demonstration of the effectiveness of
    tricyclic antidepressants2 (TCAs) have helped physicians
    to recognize and better manage this common
    disorder. The benefit of TCAs in fibromyalgia is
    partly understandable, given the high frequency of
    depression in chronic pain states.34 However, the
    improvement may be incomplete or short-lived. In a
    12-week study only 21 of 61 patients responded
    moderately or very well to cyclobenzaprine therapy.5
    Carette and associates6 found that the most marked
    response occurred in the first 2 to 4 weeks of a
    9-week double-blind trial of amitriptyline.
    The combination of lithium carbonate and
    TCAs has been used in psychiatry since 1973.7 Most
    studies of such therapy have not been controlled, but
    the large number of reports seems to indicate a
    consensus on its clinical usefulness.8 Lithium may
    augment the antidepressant effect of TCAs in resistant
    unipolar depression.9'-2 There is strong evidence
    that it also prevents the emergence of mania or
    hypomania in patients with bipolar depression during
    treatment with TCAs.7 In addition, combination
    therapy has been used for psychotic depression.'3
    The combination of amitriptyline and lithium has
    been effective in treating the painful shoulder syndrome.'
    The clinical features common to fibromyalgia,
    chronic pain states and the painful shoulder syndrome
    - depression, chronic joint pain'5 and disturbed
    sleep'4 - suggest that lithium is a useful
    adjunct to TCA therapy for fibromyalgia. I report
    three cases of fibromyalgia that was refractory to
    TCA therapy but improved markedly after the addition
    of lithium. Such use of lithium has not been
    reported previously.
    Case reports
    Case I
    A 48-year-old woman presented with a 22-year
    history of recurrent episodes of unipolar depression
    and a 3-year history of polymyalgia, polyarthralgia,
    morning stiffness, anergia and headaches. She was
    taking amitriptyline, 50 mg four times daily, and
    indomethacin, 75 mg twice daily, without appreciable
    pain relief.
    There was a full range of movement of all the
    joints except the neck, and there were no inflammatory
    changes. Multiple fibrositic trigger points were
    found about the neck, the shoulders, the arms and
    the knees. The results of tests for rheumatoid factor
    and antinuclear antibody were repeatedly negative.
    The erythrocyte sedimentation rate and the blood
    urea nitrogen level were normal. Selective radiologic
    examination revealed early osteoarthritic changes in
    the cervical spine.
    The indomethacin therapy was withdrawn, and
    treatment with lithium carbonate was started. The
    eventual dose was 300 mg four times daily, which
    resulted in a steady-state serum lithium level of 0.5
    to 0.6 mmolIL. There was a dramatic reduction of
    stiffness, pain and easy fatigability after 3 months.
    Previously identified trigger points, however, were
    still markedly tender. The patient had no depressive
    symptoms during the lithium therapy.
    The lithium therapy was stopped after 7
    Reprint requests to: Dr. Murray A. Tvber, 1483 Danforth Ave., Toronto, Ont. M4J IN5
    902 CAN MED ASSOC J 1990; 143 (9)
    months, when the triiodothyronine uptake was 0.34
    (normally 0.35 to 0.45), the thyroxine level 92
    (normally 79 to 157) nmol/L and the blood urea
    nitrogen level 4.0 (normally 3.0 to 8.0) mmol/L. The
    patient had minimal transient stiffness and pain 18
    months after the lithium therapy was stopped. She
    was still receiving amitriptyline at the same daily
    Case 2
    A slender, 49-year-old woman complained of
    pain in the neck, the shoulders, the middle and lower
    portions of the back, and the left knee since a motor
    vehicle accident 13 years before. She also had a
    history of severe recurrent headaches and three
    hospital admissions for psychiatric treatment. She
    had been given trimipramine, methotrimeprazine
    and haloperidol. At presentation for rheumatologic
    assessment she was still taking trimipramine, 225
    mg/d, and diazepam at bedtime.
    The woman appeared tense and demonstrated
    motor restlessness, pressured speech and bizarre
    posturings. There were no signs of inflammation or
    organic disturbance of the joints. Multiple trigger
    points were found in the soft tissue of the neck, back,
    hips and left knee. The results of radiologic examination
    of the lumbar spine, cervical spine and left knee
    were normal, as were those of laboratory investigations.
    The trimipramine treatment was continued and
    augmentation therapy with lithium started; the dose
    was initially 300 mg twice daily and then was
    increased to 390 mg four times daily to achieve a
    steady serum lithium level of 0.6 mmol/L. One year
    later the woman reported minimal joint symptoms
    and many days of no pain. Her affect was unremarkable
    and appropriate, and there were no overt signs
    of agitation. The blood urea nitrogen level and the
    results of thyroid function studies were normal; her
    thyroid gland was impalpable.
    Case 3
    A 3-year history of diffuse muscle and joint pain
    as well as stiffness in the elbows, the shoulders, the
    left side of the lower back and the leg prompted a
    56-year-old woman to see me. She was taking amitriptyline,
    25 mg three times daily, timolol and
    clonazepam. Four epidural corticosteroid injections
    had failed to alleviate the low back pain.
    Perphenazine, 2 mg twice daily, was added to
    the regimen and markedly relieved the pain and
    stiffness; however, it had to be withdrawn because of
    akathisia. Lithium, 300 mg three times daily (resulting
    in a steady-state serum lithium level of 1.13
    mmol/L), was substituted; it achieved virtually complete
    pain relief but produced unacceptable tremor.
    The dosing frequency was reduced to twice daily
    (resulting in a serum lithium level of 0.75 mmol/L);
    the woman experienced no tremor, but some pain
    and stiffness recurred. Attempts to increase the
    serum lithium level continued to result in tremor.
    Tenderness persisted on this regimen at numerous
    trigger points, but spontaneous pain and stiffness
    were greatly reduced.
    Only one of the patients could not tolerate the
    optimum dose of lithium. All three patients experienced
    a prompt and marked reduction of pain and
    stiffness that was sustained; two enjoyed pain-free
    days for the first time since the onset of symptoms,
    and one had minimal pain 18 months after the
    lithium therapy was stopped. Laboratory tests
    showed no evidence of lithium toxicity to the thyroid
    or the kidney, and no goitres were noted.
    Trigger point tenderness was unchanged by the
    lithium therapy.
    By definition fibromyalgia lacks both physical
    findings and objective criteria for response to treatment.
    Assessment of therapeutic efficacy is therefore
    entirely subjective and cannot be quantified. My
    long involvement with these patients, however, tends
    to substantiate their claims of marked and sustained
    improvement of their condition. None the less, these
    results need to be substantiated by further studies.
    Augmentation therapy with lithium may be
    beneficial in fibromyalgia because it enhances the
    effect of TCAs on depression. Its success may also be
    due to unrecognized causes of fibromyalgia, such as
    hypomania, that are target symptoms for lithium
    and the phenothiazines. On the basis of the results
    described here I recommend that TCA therapy be
    augmented with lithium in resistant cases of fibromyalgia.
    1. Smythe HA, Moldofsky H: Two contributions to understanding
    of the "fibrositis" syndrome. Bull Rheum Dis 1977-78;
    28: 928-931
    2. Goldenberg DL: Management of fibromyalgia syndrome.
    Rheum Dis Clin North Am 1989; 15: 499-512
    3. Kramlinger KG, Swanson DW, Maruta T: Are patients with
    chronic pain depressed? Am JPsychiatry 1983; 140: 747-749
    4. Katon W, Egan K, Miller D: Chronic pain: lifetime psychiatric
    diagnoses and family history. Am J Psychiatry 1985; 142:
    5. Bennett RM, Gatler RA, Campbell SM et al: A comparison of
    cyclobenzaprine and placebo in the management of fibrositis.
    Arthritis Rheum 1988; 31: 1535-1542
    6. Carette S, McCain GA, Bell DA et al: Evaluation of amitriptyline
    in primary fibrositis. Arthritis Rheum 1986; 29: 655-
    7. O'Flanagan TM: Clomipramine infusion and lithium carbonate:
    A synergistic effect [C]? Lancet 1973; 2: 974
    CAN MED ASSOC J 1990; 143 (9)

    I started this thread because my doctor is recommending lithium for my chronic depression issues and I found it may have benefits for pain. I make no recommendations. I was only wondering if anyone here had any experience with lithium and if it helped their pain issues.
  5. gapsych

    gapsych New Member

    Thanks. Interesting information.

    One thing that does concern me in one of the studies is the definition of fibromyalgia

    "The clinical features common to fibromyalgia,
    chronic pain states and the painful shoulder syndrome
    - depression, chronic joint pain'5 and disturbed

    Pain in the joints is not seen in FM. I am not sure what's "painful shoulder syndrome". Upon further reading it looks like the most recent study was 1998(?) and we now have more medical knowledge about fibromyalgia. Emphasis on better, LOL. Who would have thought twelve years would make such a difference in medical knowledge.

    However, I am not a doctor and you would need to weigh the positives with the negatives. Lithium is notorious for weight gain and other unpleasant side effects. This is why it is not usually the drug of choice for bipolar.

    What kind of doctor do you have? Hopefully someone who knows the ins and outs of lithium like a psychiatrist who could give you a second opinion, not because you are necessarily depressed or bipolar but psychiatrists are familiar with the drug. If this is indeed true, I wonder if a medication that uses the same mechanism of lithium but without the side effects would be effective.

    At any rate you have piqued my curiosity and I will see what information I can find.

    Keep us updated.


    Oops, looks like there is a 2003 citation.[This Message was Edited on 06/29/2010]
  6. KerryK

    KerryK Member

    Revealing Lithium's Mode Of Action
    24 May 2010

    Though it has been prescribed for over 50 years to treat bipolar disorder, there are still many questions regarding exactly how lithium works. However, in a study appearing in this month's Journal of Lipid Research, researchers have provided solid evidence that lithium reduces brain inflammation by adjusting the metabolism of the health-protective omega-3-fatty acid called DHA.

    Inflammation in the brain, like other parts of the body, is an important process to help the brain combat infection or injury. However, excess or unwanted inflammation can damage sensitive brain cells, which can contribute to psychiatric conditions like bipolar disorder or degenerative diseases like Alzheimers.

    It's believed that lithium helps treat bipolar disorder by reducing brain inflammation during the manic phase, thus alleviating some of the symptoms. Exactly how lithium operates, though, has been debated.

    Mireille Basselin and colleagues at the National Institute of Aging and University of Colorado, Denver, took a detailed approach to this question by using mass spectrometry analysis to analyze the chemical composition of brain samples of both control and lithium-treated rats stressed by brain inflammation.

    They found that in agreement with some other studies, rats given a six-week lithium treatment had reduced levels of arachidonic acid and its products, which can contribute to inflammation.

    In addition, they also demonstrated, for the first time, that lithium treatment increased levels of a metabolite called 17-OH-DHA in response to inflammation. 17-OH-DHA is formed from the omega-3 fatty acid DHA (docosahexaenoic acid) and is the precursor to a wide range of anti-inflammatory compounds known as docosanoids. Other anti-inflammatory drugs, like aspirin, are known to also enhance docosanoids in their mode of action.

    Basselin and colleagues noted that the concentration of DHA did not increase, which suggests that lithium may increase 17-OH-DHA levels by affecting the enzyme that converts DHA to 17-OH-DHA.

    By reducing both pro-inflammatory AA products, and increasing anti-inflammatory DHA products, lithium exerts a double-protective effect which may explain why it works well in bipolar treatment. Now that its mechanism is a little better understood, it may lead to additional uses for this chemical.

    From the article: "Lithium modifies brain arachidonic and docosahexaenoic metabolism in rat lipopolysaccharide model of neuroinflammation" by Mireille Basselin, Hyung-Wook Kim, Mei Chen, Kaizong Ma, Stanley I. Rapoport, Robert C. Murphy and Santiago E. Farias

    Nick Zagorski
    American Society for Biochemistry and Molecular Biology

    Article URL:

    Main News Category: Neurology / Neuroscience

    Also Appears In: Alzheimer's / Dementia, Bipolar, Immune System / Vaccines,


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  7. kjfms

    kjfms Member

    My mother was on Lithium for a long time for schizophrenia. I not a fan of that drug. It's has ruined her physical health.
  8. u&iraok

    u&iraok New Member

    I think we're talking about Lithium Orotate the mineral, right Kerryk?

    Jaminhealth, it did work pretty quickly for me but I can't remember how quickly. But when I say quickly I mean like a month or two of taking it every day. A hair test interpreted by my naturopath showed that it was so low as to be non-existent so I know I really needed it.
  9. KerryK

    KerryK Member

    When you say the supplement worked for you, what did it do for you?
  10. u&iraok

    u&iraok New Member

    It got rid of my constant low-level depression, which I didn't even know I had! I had gone thorough a serious depression many years ago so I guess I didn't think of terms of anything but serious depression, and that you could be in a state of continous mild depression.

    It changed my life, really, getting out of that and into a cheerful state of mind.

    I don't know if it will affect everyone the same way, since there's so many causes of depression but deficiences in nutrients are often a cause. But if I had serious depression or bi-polar disorder I'd check with my doctor.

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