Statement of Interest in Research on the Health Effects of Trace Lithium in Drinking Water

Published: December 2015

Correlational studies suggest that trace amounts of lithium in drinking water may have beneficial health effects, and in particular may reduce suicide rates.1 If the effect is real and there are no adverse health consequences, adding trace lithium to drinking water might save thousands of lives per year.2 However, this effect has not been tested by experimental or quasi-experimental studies, and little research has examined whether trace lithium in water is safe in all populations.3

The Open Philanthropy Project is interested in learning:

  • What is the feasibility and cost of conducting studies on the impact of trace lithium on suicide rates with significantly stronger identification than studies completed to date? Examples might include, e.g., a regression discontinuity study or a prospective cohort study.
  • What is the feasibility and cost of conducting the first cluster-randomized trials on this question? If adding lithium to a water supply is ethically problematic, could a study be done that experiments with removing differing amounts of lithium from a water supply?
  • What studies would need to be conducted to establish that trace lithium in drinking water is (or is not) safe for all populations?

If you have conducted or have considered conducting research on this topic, and you feel you can speak to these questions, we’d like to speak with you. We’re particularly interested in discussions with researchers who might be able to eventually conduct a randomized trial, though we recognize that it may be appropriate to pursue other research strategies first.

We are not yet confident enough in the expected value of further research on this topic to formally issue a request for proposals, but we would like to hear from researchers who are looking for funding for data collection or trials in this space.

Please email luke@openphilanthropy.org if you’d like to discuss this.

About the Open Philanthropy Project

The Open Philanthropy Project is a collaboration between Good Ventures and GiveWell in which we identify outstanding giving opportunities, make grants, follow the results, and publish our findings. Good Ventures is a philanthropic foundation whose mission is to help humanity thrive. Good Ventures was created by Dustin Moskovitz (co-founder of Facebook and Asana) and Cari Tuna, who have pledged to give the majority of their wealth to charity. GiveWell is a nonprofit that finds outstanding giving opportunities and publishes the full details of its analysis to help donors decide where to give.

  • 1. After learning about this topic from a New York Times piece by Anna Fels, we conducted a shallow review of the literature on whether trace lithium in water might reduce rates of suicide. (Other potential health effects of trace lithium have been studied to some extent, but not as much as the effect on suicide rates has been.) We reviewed three recent reviews of the literature on this topic (Mauer et al. 2014; Vita et al. 2015; Lewitzk et al. 2015), read the ecological studies they cited on trace lithium and suicide, and found two additional ecological studies (Ishii et al. 2015; Neves et al. 2014). Our impression from this literature is that the most persuasive studies (Kapusta et al. 2011; Blüml et al. 2013; Ishii et al. 2015, plus follow-up analyses of the same data) generally found that higher levels of trace lithium were associated with lower age-adjusted suicide rates, at least for men (who commit suicide more often than women), and at least under most sets of statistical controls attempted so far. The ecological studies which failed to find an effect may have done so due to smaller sample sizes and very low levels of naturally occurring lithium in the regions they studied (compared to those of the studies which found an association). We also note that a beneficial effect of lithium on suicide rates has some prior plausibility because lithium is already used in clinical doses (500-1,000 times higher than the trace amounts naturally found in drinking water) to treat psychiatric disorders by stabilizing patients’ mood (see our conversation with Nestor Kapusta). We are not aware of any experimental or quasi-experimental studies on the effects of trace lithium on suicide.
  • 2. One factor that increases our interest in this potential intervention is that the strategy for delivering the intervention to whole populations seems unusually straightforward, since lithium is abundant (e.g. see here) and could be added to water supplies a la water fluoridation. Our initial back-of-the-envelope calculations suggest that if either of the models in Kapusta et al. (2011) or Blüml et al. (2013) are roughly correct, a small increase in the amount of trace lithium in drinking water in the U.S. could prevent >4,000 suicides per year.
  • 3. A conversation with Professor Nestor Kapusta, September 14, 2015.