Herbs but not medications
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Herbs but not medications 

Q: I just read your article on Bipolar disorder, and I have a question...but first, you should know I also suffer from anxiety disorders, hypomania, as well as being hypothalmic*A lesser case of Bipolar disorder*...What would you suggest as an herbal suppliment to take to assist in my symptoms? I refuse to take zoloft or zannax or prozac or anything like that, but am willing to consider an herbal substitute...what do you suggest? Thanks for your time... Jon 

Dear Jon -- (Colleen handed your question on to me...) If you were sitting with me in my office, I'd start by asking you to help me understand your approach. I would want to tailor my "suggestions" to your explanation of your views. Since I can't do that in this format, I can offer my view, which of course you're free to take or leave. 
It may sound very much like a Western Medicine doctor, I'll admit; but even my local "alternative medicine" colleague thinks very much like I do and we work well together -- meaning my views are not as Western as they may sound here. 

In my view, this question boils down to advice one of my teachers offered: "you know, Jim, there are a lot of treatments to learn about out there. Why don't you start with the ones that have some evidence that they work?" Of course we have to define "work", then, no? And "evidence" -- define so that you and I know whether we're talking the same language. 

My definitions: "work" means a person is clearly better than they were before the treatment; their own opinion (better? or not?) counts just as much as some objective data like how they function. "Evidence" is the trickier one. As you probably know, in the testing most medications undergo, there is a "control group" that receives a "placebo". And, as you may also know, in most trials of antidepressant medications, the placebo group gets better -- clearly better by objective as well as their own subjective measures -- as much as 30% of the time. To me, this number is so large, and so consistent, I doubt these people are somehow "fooling themselves". They're really better. Placebo treatment really "works", making nearly 1 in every 3 people "better". 

So, any "treatment", herbal or otherwise, has to do better than that. And the only way to know if it does is to line up a bunch of folks with similar symptoms and give half the herb or drug and the other half a placebo (usually a capsule or tablet containing only sugar is used). St. John's wort has been tested this way numerous times, and seems to be better than a placebo, to pretty much the same extent as pharmaceutical company medications. 

The problem is, St. John's wort is for now just about the only antidepressant herb that's been tested like this; and when it comes to medications for bipolar disorder, as far as I know there are no "randomized trials", as these tests are called, of anything other than standard medications like lithium and Depakote; and some psychotherapies that add to medication effectiveness (better than a waiting list control group result). There is a nutritional supplement in randomized trial testing that began this past June. I've used it on one patient so far because none of the usual medications -- we'd tried all the ones with randomized trial data, and some others with less but at least some data to go on -- was working. She has not done well; I stopped it yesterday. I'll wait to make much of that option until I see some more data, particularly the randomized trial data. 

Until then, I'd urge you to follow the advice of my mentor: "there are a lot of treatments out there; why don't you start with those that have some evidence that they work" (i.e. better than a placebo; otherwise, you're really vulnerable to being taken by anyone who sings their herbs virtues well...). Dr. Phelps

Published December, 2000

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