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
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
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
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
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
antidepressants that are not antidepressants, on which many of these
"natural" options appear. Good luck with all that.
Published May, 2007