Posted by Oddzilla on June 15, 2000, at 9:56:03
In reply to Re: lithium vs. placebo - An opinion, posted by SLS on June 14, 2000, at 11:02:29
> Dear People,
>
>
> I don't think I am taking much of a risk by making the following statements:
>
>
> 1. Both lithium and Depakote (valproate) are substantially better than placebo in treating bipolar disorder.
>
> 2. Both lithium and Depakote work in the short-term and the long-term. (Depakote may work a bit more quickly in some cases)
>
> 3. People have been kept well on lithium for DECADES.
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> 4. Many people who have been kept well by lithium for years relapse within 4 months once they discontinued taking it.
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> - Many of these people respond again to lithium when it is restarted.
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> - Some of these people never again respond to lithium, regardless of how many times it is restarted, and regardless of how high the dosage is increased.
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> 5. No single antidepressant works for everyone. Mood stabilizers are no different in this regard.
>
>
> Just because some very important researchers take part in a study, this does not guarantee its reliability. If the design of a study were flawed, even Einstein wouldn't come up with the right results.
>
> > In the only long-term placebo-controlled study in 25 years of a medication used to treat clients diagnosed as bipolar, psychiatrist Charles L. Bowden of the University of Texas Health Science Center found that both lithium chloride and valproate performed about as well as a placebo in long-term treatment of bipolar symptoms, Science News reported in a May 27 edition. The Dr. Bowden's study was also summarized in the May Archives of General Psychiatry.
>
> Study URL:
> http://archpsyc.ama-assn.org/issues/v57n5/full/yoa8223.html
>
> I thought it was important to try to rip this study to shreds. I'm not sure I can. However, my conscience urges me to post on this board some evidence that lithium is an effective drug. I don't think it is in the best interests of people reading this thread to assume that the results of this study are accurate. There are some pretty big names associated with this article. However, the authors are bound by a scientific ethic to draw their conclusions based upon the results produced by their study design.
>
> It is commendable that the investigators had the courage to submit this article, despite its obviously flawed outcome. Decades of clinical experience demonstrate that lithium is indeed superior to placebo in the treatment of bipolar disorder. I had a conversation with a scientist over the weekend about this article and its inferences. He thought it likely that it was a "failed" study, and that it shows some potential problems in its designs and results. But that is opinion.
>
> Now, having said this, let me describe why reboxetine, an antidepressant, has not been approved by the FDA for sale in the United States. One of the studies that the FDA was depending on to reach its decision "failed". A study is said to fail when it is determined that the experiment just plain didn't work. The results of such a study can not be deemed reliable. Something went wrong.
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> In the investigation comparing reboxetine to Prozac to placebo, neither reboxetine nor Prozac were superior to placebo. This was a failed study. If we were to look only at this one study, Prozac should never be used again because it doesn't work. It does.
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> There are a bazillion other studies that demonstrate that both lithium and Depakote are superior to placebo - many, many of them conducted by these same researchers, including Dr. Bowden. Long-term? Well, one may want to decide for themselves as to the relevance of the Bowden 12-month study to developing a perspective of the "long-term" efficacy these drugs.
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> I don't feel like trying to pick the study apart and cite the overwhelming evidence demonstrating that lithium works. So I will try something simpler. (I hope it works)
>
>
> ---------------------------------------------------------
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>
> Questionaire: Looking for success stories only - obviously, no one psychotropic drug works for everyone.
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> 1. Has anyone found lithium effective for bipolar disorder or know of someone who has.
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> 2. For how long has lithium helped?
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> Even a handful of success stories should help allay the fears of many people reading this board that lithium is better than sugar.
>
> Just to help cover my butt on this one, I would want to point out that the population of participants on Psycho-Babble is probably sufficiently biased towards treatment-resistance to skew the statistical rate of success downward. In addition, I would guess that Psycho-Babble attracts far more people whose major complaint is depression rather than mania or hypomania. People who are manic or euthymic may have other things to do. In addition, lithium is not known to be terribly effective when used by itself to treat bipolar depression. It can, however, help prevent future occurrences.
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> Let's see what happens. I know of too many people whose lives have been changed dramatically by lithium. This contradicts the notion that lithium is no better than placebo over the long-term.
>
> Also, one other thing. The Bowden study was designed to compare the efficacy of Depakote, not lithium. I believe it was initiated and funded by Squibb, the manufacturer of Depakote. Patients were excluded if their manic symptoms were too severe. This might indicate that the majority of patients selected were Bipolar II. Bipolar II is well known not to be particularly responsive to lithium. That Depakote was somewhat superior to lithium seems to be a good indicator of this. Oh well, I guess I started picking. Sorry. I can think of more stuff, though. Again, I am not very objective on this one. Neither am I qualified.
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> Oh yeah. There is nothing prohibiting the combination of effective mood stabilizers to treat people for whom one single drug is not good enough. It works.
>
>
> - Scott~~~~~~~~
The study was published in a major medical journal , do you think it would have been accepted if the experimental design was so obviously flawed? Wouldn't it have been subjected to "peer review" before it was accepted?How can there be a flawed outcome to a scientific experiment? Isn't that the point of science? To report the results? We all ways had to write in indelible ink in lab books when I took science classes!
I don't see any real point to anecdotal evidence that people have been mania free on lithium-after all the study didn't say it never works, it said it didn't work any better than a placebo.
I certainly think people should take lithium if they want to and think it helps, but I don't think it is necessary to give up one's objectivity about it. I was personally delighted to see a long term study being done. It seems like they are few and far between.
I do understand your concern though. I think it's like the reaction I have to the studies that claim alcoholics can drink moderately again. It may be true at least for some but the destruction to those who weren't able to would be so great-it's a little scary to hear.
What would be so bad if a large percentage of "cures" came from placebos? If it works it works!
Oddzilla
(not any of the bobs, not clare,
not Cam, just odd that's all)
poster:Oddzilla
thread:36179
URL: http://www.dr-bob.org/babble/20000610/msgs/37389.html