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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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