Q:  Flax Seed Oil & Mood Disorders:  Lithium Level of 0.45- Therapeutic?

My doctor has suggested using Flax Seed Oil in combination with a lowered dose of Lithium.  (My blood work shows my Li level at 0.45).

I am concerned because this level is not in the therapeutic range.  What is your opinion?

Also, where can I find research to substantiate the use of Flax Seed Oil for use with mood disorders.

Sincerely,


Dear Ms. S.' --

The therapeutic range for lithium is really used to tell us when a person has enough lithium onboard to prevent the recurrence of a manic episode or a severe depressive episode, for those people whose episodes are separated in time by periods of relative wellness. As you can imagine, during such periods of time, one must have some means of knowing whether a treatment is likely to have that "preventive" effect, without waiting for the emergence of symptoms which could be quite disastrous.

Over time, experience with lithium used in this fashion has shown that a blood level less than 0.5 (some would say 0.7) is less likely to provide that preventive benefit.

However, we routinely get lithium levels when we are not interested in this minimum therapeutic level, but rather checking to make sure that the blood level is not so high as to be near the other end of the therapeutic range, namely going too high. As you know, too high a lithium level can be quite dangerous and we can avoid taking that risk by demonstrating that a patient's blood level is well below the upper threshold (which for some patients, and some laboratories, is given as 1.5; but you will also see 1.2; and some patients actually developed symptoms of lithium toxicity at blood levels as low as 1.0, so monitoring closely when blood levels are in this range is necessary).

For other patients who do not have "well intervals", we do not have to go by the blood level to know if the medication is working. We can simply look at whether it is controlling the target symptoms or not. In this case, the purpose of the blood level is just to check and make sure it is not too high (or to put a "stick in the sand" to mark a blood level that was either working or not working).

Therefore, a lithium level at 0.45 is not necessarily a problem. It would be routine to lower a lithium dose to try to minimize side effects, hoping that the benefits would continue even at a lower dose. If some of the benefits began to diminish, one might then augment with another similar tool, including perhaps Omega three fatty acids. 

Usually these Omega threes are obtained from fish oil, and that is that it approach that has been studied in research trials. To my knowledge, there has been no research trial using flax seed oil. There is some reason to think that it could work, as one component of flax seed oil can be metabolized to omega-3 fatty acids. For more details, see my webpage on Omega threes and flax seed in which this chemical pathway is described. That page also explains why in some common circumstances, one could not be certain that the flax seed oil would be metabolized as hoped. Basically, other common dietary elements can get in the way.

Thank you for that interesting and relevant question.

Dr. Phelps



Published May, 2007