I've lived with the diagnosis of clinical depression for 10 years after seeing a psychiatrist once after a suicide attempt i've been on numerous anti depressants and had a manic episode after being on 250mg of effexor now I am a ultra rapid cycling BP and no meds are working. I am on Lithium, Clonazapam, Topamax, Epival, and Serequel. I still continue up and down and have had suicide attempts.  Have you heard of Truehope Synergy? ITs a mix of vitamins and minerals and is said to work what do you think?


Dear Ms. C'-- 
Yours is an unfortunately frequent question:  what do you do after you've "tried everything"?  Should you consider things like the TrueHope.com approach, or Omega-3 fatty acids, or other approaches for which there is some but only a little evidence that they "work", and very little evidence to go on as far as risks one takes in trying it?   

The answer in some respects depends on how much risk you are willing to take.  The big problem in trying brand new treatments is not so much the "will it work?" question but the "what's the worst thing that could happen?" question.  When a compound is first being tested to see if it will work, the evidence we accumulate is primarily about the first question, obviously; and then it takes some time before we can even begin to answer the second one.  

However, the team researching the E.M. Power Plus compound (the one that TrueHope.com is marketing) has not reported any major problems with the compound yet, and they've been at this for several years now.  Of course you'd face a different question if it "worked", which is "what's the risk of staying on this stuff for years?"  But you could cross that bridge once you knew it really could help you.  

But the phrase "I've tried everything" is pretty tricky too.  For example, I'd bet you've not had lithium, Epival (valproate, or Depakote in the U.S.), and carbamazepine or oxcarbazepine, all at the same time and without an antidepressant.  In fact, since your doctors are just now figuring out that antidepressants carry substantial risk of inducing manic symptoms per your recent experience, I'd bet that most of the previous mood stabilizers you've had have been used with an antidepressant.  In my opinion that means that most of the treatments you've ever had (if I'm right about these guesses) would need to be repeated without the antidepressant.  In that case you'd be a long ways from having "tried everything"; you'd be closer to the beginning of the process than the end!  Combinations of two mood stabilizers, and then a few combinations of three, sound like a lot of medications but are pretty standard things to try as I watch what the experts at the National Institutes of Mental Health, here in the U.S., do, for example.   

As for my personal opinion about Truehope, for which you asked:  I've been waiting to try this stuff with any of my patients.  I've only had two patients get to the point where I was pointing out to them that this alternative exists.  That is, these patients had indeed in my opinion "tried everything".  One of them tried it while she was waiting to get ECT, which fortunately worked for her.  While she was going up on the dose she got an unusual heart rhythm and got a bit scared about the stuff and stopped.  It didn't help that she was pretty wary about it from the beginning.  That's the only experience I've had with it so far.  

So I continue to wait for more evidence, especially regarding risk.  As my dentist says, "I don't like to be at the front of the pack.  I don't like to be at the back of the pack.  I like to be somewhere around the front of the middle!"  (Unless there is no pack in sight, and a possibly helpful agent for which we do have information about risk is available, such as may be the case with thyroid and perhaps even glucophage).  

Dr. Phelps
 

Published November, 2002