Posted by Squiggles on July 30, 2007, at 8:08:13
In reply to Re: lithium » Squiggles, posted by Larry Hoover on July 29, 2007, at 14:15:04
Hi,
Sorry i didn't get back to this yesterday.
> From your referenced piece: "Although this effect of lithium is probably functional and reversible early in treatment, it may become structural and irreversible over time."
>
> Let's recap the sequence of debated issues.
>
> You initially questioned the sociological value of patented drugs, arguing that generics would be of greater value to society.Actually, i questioned the motive of the manufacture of generics. The sociological value could easily be got by making all drugs cheaper.
>
> You then questioned if lithium could have been patented, and suggested that drugs (such as lithium) from the 1950's were somehow both cheaper and superior to later developments.
>
> I then entered the discussion, suggesting that doing away with drug patents would destroy drug research and development as it is presently conducted. Furthermore, I declared that lithium would never be approved under current drug testing guidelines. Although a minor point in what I had written, you chose to focus on that one issue.Two different issues here: i don't know if it's true that patent protection has in any way delivered great strides in medication, in comparison to the old days. Second issue: could you tell me why you think that lithium would never pass testing guidelines today?
>
> I won't re-argue the presentation of evidence, but I believe that the null hypothesis is inconsistent with the body of evidence. I reserve my conclusions until after studying the data, to avoid confirmation bias. (However, I also accept that to believe that might also demonstrate bias. I am reminded of Escher, but I digress....)
Yeah, you digress-- i don't understand what your point is here.
>
> What is most interesting to me is that, despite your protestations that lithium is safe to the thyroid and the kidney, your own doctor routinely tests these functions. You seem to derive some comfort from this. I suggest that you have simply been lucky, both in having the doctor you have (only about 1/3 of lithium-treated patients even get routine thyroid testing), and in the negative results therefrom.There are many drugs given today (e.g. some heart drugs, diebets drugs, which require regular monitoring. This should not be an argument against the efficacy or safety of a drug, except perhaps for economic reasons to the hospital.
>
> Generalizing from your experience, one might conclude that lithium is safe. However, the experience of others is also relevant to the issue of safety.
>The experience of others? Well, last night i went to one of the most meticulous psychiatrists in the United States, and read what he had to say
about lithium neurotoxicity. That would Dr. Sheldon Preskorn.From what i recall, he points to the dangers of neurotoxicity, not on lithium alone, unless it is a dose related problem (that is mostly over 1.5 blood level leads to brain and acute renal toxity-- apparently the two are related).
The combination of drugs such as Haldol and lithium or tricyclics and lithium, and other well-known factors such as electrolyte imbalances, diet, dehydration, diuretics, NSAIDs, ibuprofin (which by the way i took through many yrs. of my life and noticed i felt sick-- stupid monograph didnt't tell me then), --it hought it was the ibuprofin, but it was the interaction).
Also, the absence of benzos which are commonly used with lithium for bipolar disorder. I found this interesting, because when i was withdrawing from benzos, i got a seizure, which may not have been withdrawal but actually NMS, or both.
Dr. Preskorn also mentions something found in Dr. Schou's works, that clinical testing in lithium should take into account the picture between blood serum levels and brain toxicity-- something which I am sure is rarely done. Dr. Schou had pointed out that a lithium holiday would be appropriate for chronic users because of the accumulation of lithium in the brain. I think that probably is the case for many other drugs as well. But this kind of clinical care is way beyond the means and economics of present mental health resources.
Age is another factor he mentions.
But all these factors are common to many psychiatric drugs, and with the new ones, who knows what we will discover in a decade or two after the population has been exposed to them.
So lithium is not a drug to be excluded but to be monitored.
Here are some interesting hits:
http://psychservices.psychiatryonline.org/cgi/content/full/52/2/229
http://www.preskorn.com/columns.html
http://www.clinchem.org/cgi/content/full/44/5/1073
Squiggles
poster:Squiggles
thread:772306
URL: http://www.dr-bob.org/babble/20070730/msgs/772837.html