Last year, Lady Gaga opened up about her mental health journey, admitting she had suffered a psychotic break and filmed her hit movie A Star is Born while on a controversial medication. Now, a mental health expert has revealed everything to know about the drug, which has long been under scrutiny because of its high risk of misuse and high risk of toxicity, and revealed a potentially safer, cheaper alternative. In an interview with Rolling Stone in November, the 39-year-old music icon revealed that she filmed her 2017 film 'on lithium,' a mood stabilizing drug typically used for treating bipolar disorder. Affecting between seven and 10 million Americans, bipolar disorder causes extreme mood swings that alternate between extreme highs - mania - and lows - depression.

Gaga has not confirmed a bipolar diagnosis, but she noted that on her Joanne world tour in February 2018, she suffered a psychotic break and checked into the hospital for inpatient psychiatric care. 'I needed to take a break. I couldn’t do anything … I completely crashed,' she said. 'It was really scary. There was a time where I didn’t think I could get better.… I feel really lucky to be alive.' Gaga has previously said she has been diagnosed with post-traumatic stress disorder (PTSD) and depression. Lithium carbonate is a centuries-old mood stabilizer derived from the mineral lithium. It was discovered in 1817 and used as early as 1871 for mania. It was approved by the FDA in 1970 to treat manic episodes in people with bipolar disorder. Though it's considered a gold standard therapy, it can come with a host of side effects such as shaky hands, frequent urination, nausea and excess thirst. Additionally, though lithium carbonate is not addictive or habit-forming, it is possible to overdose accidentally or intentionally. Lithium orotate, meanwhile, is a dietary supplement form of lithium that emerging research suggests may have mood, cognitive function and stress benefits without a prescription.

'Lithium is one of the most truly amazing minerals,' Dr James Greenblatt, a dual board-certified psychiatrist and assistant clinical professor of psychiatry at Tufts University School of Medicine and Dartmouth College’s Geisel School of Medicine, told the Daily Mail. Greenblatt, who has been studying the effects of low-dose lithium for 30 years, says he prescribes prescription lithium carbonate to patients with bipolar disorder based on their needs but recommends lithium orotate for more generalized mood swings, impulsivity and irritability that do not fall within bipolar. One of the main differences between the two drugs is the dose, he said. Doses of prescription lithium vary for each patient, but it usually ranges from 600mg to 1,800mg once per day. Supplements, meanwhile, are usually around 1mg to 5mg once daily. Lower doses are less likely to cause side effects, Greenblatt says. 'I think most psychiatrists would agree that lithium is one of the best medications that we have in psychiatry,' he said. 'But it has potential side effects. So high-dose, long-term lithium has side effects that we need to worry about.'

With lithium orotate, however, 'we see very few side effects,' he added. Rare but potentially serious side effects of lithium carbonate include weight gain, thyroid dysfunction, kidney damage and cognitive impairment. Hair thinning, dizziness, confusion, severe nausea and tremors have also been reported. Lithium orotate has been associated with more mild nausea, diarrhea, stomach pain, tremors, increased thirst, frequent urination and, in rare cases, kidney damage. Greenblatt also noted that while there 'are many, many roles for low-dose lithium, one of them is not treating bipolar. 'You need, at least for a while, the prescription,' he added. Prescription lithium must be given by a psychiatrist. Cost is another factor. Lithium orotate costs between $10 to $30 per bottle, depending on the size and the brand, and does not require a prescription.

Lithium carbonate, meanwhile, needs a prescription, and the cost depends on insurance coverage. Brand name lithium (sold as Lithobid) can cost as much as $800 for 60n pills without insurance, while generic versions are around $50 to $200 for a month's supply without insurance and $20 to $30 with insurance. As part of its mental health benefits, recent research suggests low-dose lithium supplements may have profound effects on [depressed] patients. A 2021 review encompassing nearly 2,700 global regions and 113 million people, for example, found higher concentrations of lithium in drinking water were associated with lower [self-murder] rates and inpatient psychiatric admissions. Lithium can enter drinking water through natural weathering of rocks and soil as it dissolves into groundwater. The Environmental Protection Agency (EPA) states that water-only exposure to lithium is unlikely to cause health concerns. 

Improperly disposing of lithium-ion batteries can also lead to more severe contamination in the water. Greenblatt also pointed toward a 2025 study from Harvard University researchers, which studied the effect of lithium orotate supplements on Alzheimer's disease, the most common form of dementia that affects about 7 million Americans. Based on mice and human models, they found when toxic amyloid beta begins to form brain deposits in the early stages of dementia, it binds to lithium and reduces lithium function in the brain, which may damage brain cells and trigger memory loss. However, treating mice in the study with lithium orotate evaded amyloid beta, prevented brain cell damage and restored memory.

'Over many, many years, we know [lithium orotate] has many effects on the brain. It effects neurotransmitters, it decreases inflammation, it increases chemicals in the brain that help neurons grow,' Greenblatt told the Daily Mail. 'It's truly a remarkable mineral that we're just accumulating more and more research as to what this micronutrient does in the brain. Greenblatt recommends anyone curious about lithium orotate to stick to doses between one to five milligrams. 'Over that dose, they should be working with a medical professional,' he said. And even at low doses, he urges potential patients to speak with a healthcare provider before starting.