Q's re. BP & Alternative/Homeopathic Treatments
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Q:  Q's re. BP & Alternative/Homeopathic Treatments


Is there a center anywhere that specializes on alternative/homeopathic treatments for bipolar disorder? 

Should one be tested for hormonal/mineral deficiencies, thyroid or other endocrine disorders? 

Who/where can one get a more holistic approach to diagnosis and treatment?


Dear Tina --
The short answer is “not that I know of (though surely there’s something out there).”

But I will take the liberty of offering you a longer answer, as just today I saw something very disturbing that relates to your question. I was looking for a home for it.

Okay, so first off, I’ll presume there’s a strong reason for you to seek and prefer “alternative/homeopathic” treatment.  Usually this is because the prospect of standard diagnosis and treatment looks scary, for some reason. Often there’s someone you’ve seen who had a really bad experience with standard medical care for bipolar disorder.

And there are numerous other reasons for being very wary of standard psychiatric treatment for mood disorders. Most of the treatments carry substantial risk, for example.  Many of them make people feel lousy, even if they might be reducing the original target symptoms. Whatever the reason for your hesitation to get involved with traditional medicine (which is perhaps being offered to your family member), skepticism is entirely understandable.

On the other hand, there are some pretty good reasons to be skeptical about "alternative" approaches as well.  As long as the same degree of skepticism is applied all around; and as long as there is a willingness to rigorously compare the risks of no treatment, or ineffective treatment, versus the risks of treatments being offered -- then I generally applaud skepticism.  For one thing, it lowers the risk of raised hopes, which can lead to dashed hopes.

Here are three reasons to be skeptical about alternative/holistic treatments. Warning: this is a long diatribe, as it turns out, and it’s not an answer to your question. So you could stop here. Read on if you’d like to see my related thoughts on this issue.

1. For some reason, people don't seem to hold alternative/holistic/natural treatments to the same standards as traditional-medicine treatments, regarding evidence that they actually do something helpful. I think there is some perception that because the treatments might carry less risk (because they are "natural" in some way) they don't actually have to have as much evidence that they really work.

And that is a big problem.  Placebo treatments for mood and anxiety disorders generally work very well for between one quarter and one third of people who try them.  This means that 25-33% of the time, any treatment that is relatively convincing might be effective.  There are plenty of sharks out there who know this and are selling treatments, some of which they actually know don't work, to an unsuspecting public -- who, ironically, is actually getting better from those treatments at least one quarter of the time!

I suppose that on this basis, you could say "well, why don't I start with one of those and heck, if I get better, great.  I don't care if it was really a placebo -- I'm better!" As long as you don't start out too skeptical, this ought to work about a quarter of the time. If you are going to go that route, pick something that is cheap and pretty guaranteed to be harmless.  Actually, we have a great candidate for that.  Ironically, it even has some evidence for efficacy, unlike many such things: Fish oil. Another up-and-coming non-pharmaceutical approach to bipolar depression (anything one tries is probably better if it has demonstrated efficacy against bipolar depression, as that is the harder component to treat, generally), is N-acetylcysteine.  This one also is relatively cheap (even available by prescription, so you can make your insurance company pay for it, if you have one; heck, you gave ‘em a lot of money already, why not?).  And it has been around under medical scrutiny for over a decade, lowering the chance that something unusual will pop up 10 years from now in terms of risk.

2.  Although it's not clear yet, there may be some very substantial risks in leaving symptoms poorly controlled.  In other words, turning first to treatments that may not have very good evidence for their effectiveness introduces a potential delay in getting symptoms under control -- and that delay may have risk in itself.  Accumulating evidence suggests that ongoing mood symptoms are associated with brain atrophy, and perhaps even some brain remodeling that is hard to reverse.  This may be particularly true for severe symptoms (so if your or your loved one's symptoms are not so severe, this may not be such a big deal).

3.  (Boy, I can really see how far my knee has jerked on this reply.  I hope you recognize the you did not precipitate this long diatribe all by yourself. It was all ready to go, before your question arrived! Thank you for your patience.  One more point.)

Some purveyors of alternative/homeopathic treatment definitely have their heart in the right place.  Even if their treatment is not really better than a placebo, they are trying hard to help people.  Good evidence suggests that this factor alone is likely to help them get good outcomes.  I certainly do not fault the intentions of such practitioners.

But just today, I saw evidence that a pharmaceutical company, of all of things, was deliberately setting out to dump a treatment which they know to be ineffective on the "homeopathic" market.  To me, this suggests that they know people are willing to pay money for something, whether there is evidence that it works or not -- they just have to market it right.

As you can probably tell, this really fries me.  So here is the example: after research demonstrated that an amino acid variant did not prevent Alzheimer’s disease, the manufacturer turned to releasing a similar molecule as a “nutraceutical” (tramiprosate, which didn’t work, is a modified version of taurine, an amino acid; now the company will release homotaurine for “the massive US market”.)  Look at the spin being applied to this product: Vivimind (good name, eh? hey, spin it all you can if you know it doesn’t  work!).  Wait a minute, though: the website says that this new dietary supplement… protects memory function, backed by 15 years of research and clinical testing in more than 2,000 individuals. “  Their CEO said"With a firm scientific profile for VIVIMIND established after more than $200 million in clinical research, we now look to secure partners 
to help bring this unique product to the U.S. market”.

After claiming that the product preserves memory, protects brain structures, and sustains brain cell health, among other things, their site notes (asterisk at bottom of page) that these claims have not been evaluated by the FDA. Well, related claims were, just recently, in their attempt to demonstrate benefit versus Alzheimer’s disease. The trial was negative, meaning tramiprosate was no better than a placebo. So they won’t be getting FDA approval. I can’t tell for sure but I’ll bet those are the 15 years of research and 2,000 patients being referred to.

What, do they just think people are stupid?  After I wrote the rant above, I surfed a bit further looking for any evidence this stuff actually works. Then I ran into a couple of other sites offering the same rant: a pharmacist; and a professor of philosophy wondering about the ethics of all this

My worry is that this example is not the only example, just the most recent (caught, this time).  What’s the alternative? Stay skeptical all the way around: same “prove it to me – low risk, low cost, and good chance for benefit” for all treatments offered. Bravo for that.

Thanks for the opportunity to go wild with this little essay. My apologies if it ends up being offensive somehow.

Dr. Phelps

 

Published October, 2009

 

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