Posted by madhatter on March 25, 2007, at 19:17:28
In reply to Re: Orthomolecular treatment for bipolar disorder, posted by madhatter on March 25, 2007, at 18:31:14
This is an attempt to deconstruct the evidence for the use of psychotropic drugs as a life time maintenance treatment for bipolar disorder and monitor what level of risk I am taking by being non-compliant with medication. It is not meant to encourage anyone to do as I am doing, but to review the literature and interpret my own non-compliance in terms of the risks involved.
Geddes at al (2004) conducted a systematic review and meta-analysis of randomized controlled trials of the use of lithium for long term therapy for bipolar disorder.
Despite the fact that lithium has been used for over 50 years, only 5 randomized control studies met the criteria for inclusion, giving a total sample of 770 people covered by the trials.The overall relapse rate indicated that the risk of relapse was 60% for placebo and 40% for lithium (this is considered statistically significant) For depressive relapse there was no statistically significant difference in relapse rates (25% on lithium vs. 30% for placebo). For manic relapse the risk of relapse was 14% on lithium vs 24% on placebo ( statistically significant). This supports the common belief that lithium is better for preventing mania than it is for depression.
The main adverse events for lithium were somnolence, nausea and diarrhea.These trials were conducted with followup periods ranging from 11 months to four years. There is no research on longer term use that I have found on the use of lithium for a lifetime.
I remember having read an article on differential responses to lithium indicating that people experiencing dysphoric mania (irritable ratbags like me) are more likely to relapse on lithium than those who experience classic elated mania., but having been disorganized I have not got the reference at the moment.
So based on this stuff, and treating my alternative diet, supplements, CBT , meditation as a placebo, there is a 24% risk of me having a manic episode and being forcibly hospitalized by relying on my placebo. There is a 14% risk it would happen if i WAS taking lithium, so the actual risk that I am taking it will happen is 10% more likely than being on lithium.It’s a risk I’m willing to take, as I have found alternative ways of controlling the depressive symptoms.
Ref: http://ajp.psychiatryonline.org/cgi/content/full/161/2/217
poster:madhatter
thread:744029
URL: http://www.dr-bob.org/babble/alter/20070320/msgs/744209.html