Q: Q's re. BP &
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
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,
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
Thanks for the opportunity to
go wild with this little essay. My apologies if it ends up being offensive
Published October, 2009