Q: Flax Seed Oil & Mood Disorders: Lithium Level of 0.45-
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
Also, where can I find research to substantiate the use of Flax Seed Oil for use
with mood disorders.
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
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
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.
Published May, 2007