"Holistic" Treatments & Bipolar Disorder
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Q:  I have been on just about everything for bipolar and depression but nothing last. I want to look into holistic healing and get of all drugs. Have you heard of any success stories?

Dear Mr. K' --

Well indeed, there are many success stories with many different "holistic" approaches. I suppose we could characterize this class of treatments as those which are "natural", in some fashion; or a least not manufactured by a pharmaceutical company.

The problem is, for mood disorders generally, there is something very remarkable about a treatment which one believes can really help: they often do. In research studies using a "placebo" control group, in studies of depression for example, the participants in the control group generally have about a 25 to 30% response rate. In other words, about one person in four, and sometimes closer to one person in three, will show a clear response to the treatment (in general, response is defined as at least a 50% reduction in depression scores).

This is often dismissed as a "placebo response", as though this means that it is not "real". And yet, there is no question that those depression scale scores did indeed go down. In my view, what we see here is our remarkable capacity to heal ourselves, if we believe that what we are doing really can help. It is not "fake", and it may even be a lasting response, although this is less well studied.

Therefore, any treatment that you undertake should have at least a 25% chance of being quite effective (although the goal with treatment is not just to achieve a 50% reduction in symptoms, it should be a complete remission of symptoms, and the percentage of patients who reach this goal on a placebo is much smaller).

As a result of all this, there are many treatments out there which very reasonable people believe very sincerely are "effective". Indeed, for some people, the treatment they have so benefited from has indeed "worked". The key is to believe when one starts that it is very likely to cause benefit. This believe can be engendered by the person who offers or prescribes the treatment, or through the research and hope of the person who takes the treatment.

However, to know that a treatment is truly better than a placebo, one must conduct a research study in which the treatment is compared to a control treatment, where the latter is presumed to be a "sham": in studies with pills, this is generally an inert compounds like sugar, made up to look like the treatment pill. In studies of light therapy, the "sham" treatment was a low dose negative ion generator in some studies, or I dim red light.

Moreover, patients must be "randomized", meaning that they must be randomly assigned to receive either the research treatment or the placebo. In the best studies, neither the patient nor the researchers will know who is getting the real treatment, and who is getting the placebo: they are "blind" to the patients' treatment condition. Thus, these studies are called "randomized, controlled, double blinded clinical trials". 

Of course all this takes a considerable amount of funding, and therefore many of the "holistic" treatments have not been studied in this way. They could indeed be more effective than a placebo, but we do not know because there has been no such research.

Mind you, all of this research is only able to tell us about effectiveness. It does not generally have anything to say about the potential risks of a treatment. For this, we need ongoing monitoring of patient outcomes, first in the randomized trials themselves, and then by keeping track of adverse events experienced by patients on treatment. To really get an idea of what kind of risks a treatment may pose can take many years. Until a treatment has been in common use for at least several years, allowing for observation of many patients over a long period of time, we should presume that it's risks are largely unknown.

To sum up then, if you elect "holistic" treatments, you are almost inevitably electing those for which there is no clear evidence of effectiveness (greater than a placebo, which is not to be dismissed, but which also should not cost very much money!), and very little experience by which to judge risk. Again, that does not mean that such treatments are not more effective than a placebo, and perhaps even quite harmless -- we just don't know, and neither would you when you purchased it and put it in your mouth.

Finally, to make sure I am not misinterpreted, all of the above is not to say that medications made by pharmaceutical companies are the only treatments to consider. Indeed, there are some treatments which are "natural" for which we do have good evidence and lots of experience. This includes at least lithium, fish oil, thyroid; as well as exercise, psychotherapy, and perhaps one could even include light therapy.  Since your difficulty has been bipolar depression, you might want to look at my list of
nine antidepressants that are not antidepressants, on which many of these "natural" options appear.  Good luck with all that.

Dr. Phelps


Published May, 2007

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