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Q:  I would like to know what you know about orthomolecular psychiatry and treatment with amino acids and nutrients. Also, what do you make of this list of the three most common causes of bipolar disorder:
http://www.alternativementalhealth.com/articles/commoncauses.htm

Thanks.
 

Dear Matt -- 
Caution, knee jerking wildly, stand back:  my thoughts about most anything that offers itself up as a treatment all begin the same way -- I'm interested, just let's start by showing me some evidence that the proposed treatment works better than a placebo.  After all, placebos work pretty well in my business, at least 25% of folks with depression improve (defined as dropping their depression scale score in half, from before to after) on them.  So, fine, somebody has a treatment to offer, great:  but let's just wait to see if it can be shown to work better than a placebo before we get too excited about it.  

As for the three most common causes: as readers will note from the link Matt provides, these causes are put forth by Dr. William Walsh.  His website is linked from this article, at the top.  Going to his website, one finds his for-profit clinic: so automatically, your caution lights should be on, as here is someone who makes money by treating patients, directing more potential patients to his practice through his article.  

But wait, his website also links his recent article on treating violent behavior with "biochemical therapy" (an interesting term in itself), an article published in a respected journal.  Though I have not dug up the article itself, anyone who knows what to look for should be able to tell that the article describes what is technically called an "open trial", which differs from a "randomized trial" through the lack of a control group.  In other words, there is no placebo treatment in this study.  Open trials are not "bad", they just aren't placebo-controlled, and so (back to the knee-jerking again) there is no way to tell if the patients Dr. Walsh treats might get as much better if he was to give them sugar pills.  Mind you, the test we'd want to do would be for Dr. Walsh to give them sugar pills and keep everything else the same about how he treats the patients:  same empathetic listening, same concerns expressed, same interest in how things turn out, same close follow-up to see how things are going -- all of which is part of a good placebo treatment.  

And the most important ingredient in a good placebo:  Dr. Walsh almost certainly  believes very strongly that his treatment is going to help.  That ingredient has been shown to be crucial, and powerful.  

As you can tell, it concerns me that someone is offering a treatment to patients that he himself cannot know is really helping, beyond a good placebo response.  Note that people will be coming back to him all the time, telling him how much he has helped them -- probably as many as 1/3 of all the patients he treats, but at least 1/4 of them, as 25% is a common placebo response rate.  That one in 4, or 1 in 3, also believes that Dr. Walsh's treatment is the thing that made them better.  They are likely to reinforce his belief that his treatment is a good thing (a belief that his website makes quite clear).  So Dr. Walsh cannot know whether his treatment works by listening to his patients.  

Take a look at his publications:  do a PUB MED search and enter Walsh WJ.   I did so looking for any randomized trials of his treatments he might have published in the past.  I do not see evidence of such research, or of any research he has published supporting his assertions about the three most common causes of bipolar disorder.  

Of course you could wonder:  does Dr. Phelps have publications supporting his treatments?  What will we find if we do a PUB MED search on his publications?  There's only the article I wrote as a medical student, a review of the health benefits of exercise.  No research, certainly no randomized trials with placebo groups.  But as you may have seen from my website, there are plenty of references to randomized trials of treatments there (e.g. see the mood stabilizer page, which compares treatments based on whether they have placebo-controlled trials or just "open trials", such as Dr. Walsh's.  
 
Wow, that knee really goes, when it goes, doesn't it?  

Dr. Phelps


Published Jan. 2005
 

 

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