DEAR DR. ROACH: Would it be risky to take a low dose (20 mg) of over-the-counter lithium orotate to treat cognitive decline? The recent study in the journal Nature recommended waiting for further studies to look at the benefits and risks of taking this compound. Given the promising findings in mice/rats and the anecdotal evidence of reversing memory loss, I’m inclined to roll the dice and give it a whirl. — J.H.R.

ANSWER: I can understand your enthusiasm. There have been several studies (some in mice, like the Nature study you mentioned, but others in humans) that have consistently shown a slowing of disease progression and a reduced risk of developing Alzheimer’s disease in people with mild cognitive impairment. Interestingly, places with low amounts of lithium in the drinking water have more dementia, leading some authors to speculate that “lithium deficiency” is a risk for dementia.

In the studies done on humans, doses were carefully adjusted to a blood level where side effects are less likely. Lithium used for bipolar disorder at doses that are roughly double the ones used for dementia prevention can cause serious changes to the regulation of salt by the kidney and brain, as well as thyroid abnormalities.

Since the metabolism of lithium is highly variable from person to person, the dose you are speculating about might not be enough to get your blood levels into the range that was used in the studies. But it might be high enough to put you at risk for serious side effects. I don’t know if your doctor would be willing to check your blood level, which is how the studies were done.

In my opinion, the literature does not yet support the use of low-dose lithium to prevent dementia.

DEAR DR. ROACH: What is the difference between antibiotics and antivirals? — A.T.G.

ANSWER: Antibiotics are an effective treatment for bacteria. Some antibiotics are very broad, meaning that they can kill a large number of pathogenic (harmful) bacteria, while others only kill a few. There are many different families of pathogenic bacteria, and there are hundreds of antibiotics.

Because resistance to antibiotics is a huge problem that continues to worsen, we try not to prescribe antibiotics unless they are really necessary. Patients can help by not insisting on antibiotics. Antibiotics don’t work on viruses, which are by far the most common cause of colds, and can also cause many other infections, such as many cases of meningitis.

Antivirals are specific treatments for viruses. Unfortunately, we only have effective antivirals that work against relatively few families of viruses. One of the first antivirals was acyclovir, which remains an effective treatment for the eight types of human viruses (and the one animal herpes virus that can infect humans).

A major success in antivirals is the development of highly effective agents against HIV. The immense amount of work that went into making treatments for HIV paid off in the development of treatments for a different virus, COVID-19.

COVID-19, a specific coronavirus, has two main antivirals, including the oral drug nirmatrelvir. (It is given along with ritonavir to increase how long it stays in the body, and the combination is sold as Paxlovid.) A different antiviral, remdesivir, is given intravenously to hospitalized patients with severe COVID-19. Scientists who study COVID-19 remain alert for newer variants of the virus, which might cause a resistance to Paxlovid and other treatments.

Antiviral drugs are not effective against bacteria. With severely ill hospitalized patients, we occasionally start them with both antibiotics and antivirals when it’s not clear which type of infection it is, then stop the unnecessary drugs when lab tests identify the cause.

Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu. (c) 2025 North America Syndicate Inc. All Rights Reserved