Lithium, Bipolar and Creativity

creativityA very talented writer who we’ve been seeing for about six months has noticed that her creativity seems to be way down. Creativity is a fundamental part of her view of herself. She is very upset.

Her concern is that the lithium she has been taking might be the cause. However, she has been quite depressed for the last month.

What do we know about lithium and creativity? How do we figure out what is caused by lithium and what is caused by depression? In other words, is it the treatment that’s causing the problem, or is it the underlying condition?

I went to the UCSF library and searched medical journals to find studies relevant to this question.

It turns out that there’s only one study about lithium and creativity. It is a 1986 study that found that there was a statistically significant increase in creativity after lithium was abruptly discontinued.

The study looked at people’s ability to come up with creative word associations. It involved 22 individuals who had a good and stable mood. They were on varying doses of lithium, and they were tested before and after abrupt discontinuation of lithium, and then again after the lithium was resumed.10-2-2013 7-32-42 PM

As I noted in the intro, the study found that numbers of creative word associations were higher after the lithium discontinued. There were about 10% more word associations made without lithium than while the subjects were taking lithium. In other words, creativity was reduced by about 10%.

It turned out that this effect was only seen at higher levels of lithium, at blood levels of 0.8 or below, there wasn’t any negative effect of lithium on creativity.

One potential confounding factor in assessing this study is that abrupt discontinuation of lithium is associated with an increased incident of energized states (hypo-mania and mania). We also know that an energized state is associated with increased creativity. In other words, was some of this increase in creativity due to a transient energized state that was induced by abruptly stopping the lithium?

I am inclined to think that there is some negative effect of lithium on creativity at higher doses. The effect is not large.

I then turned to the literature on mood effects on creativity. There are more studies on this topic. One recent one 10-2-2013 7-33-47 PMnoted big changes in one measure of creativity, depending on whether one was manic or depressed.

Reductions in creativity between these two mood states were quite large.  Creativity was reduced by 30% to 40 in depression (compared with mania).

What is the take-home lesson of this research?

Lithium does affect creativity, but its effects are significantly less than mood effects.  So the first place to look for sources of reduced creativity is inadequately treated depression.  If lithium is part of what’s treating depression, and is having even a modest beneficial effect, then the net effect of lithium is likely to be positive, especially if your dose is below 0.8.