3 ms·

> that mood stabilizers (lithium, depakote, carbamazepine) are better first-line drugs for depression with cyclic course than the SSRI drugs When these "work,"

> that mood stabilizers (lithium, depakote, carbamazepine) are better first-line drugs for depression with cyclic course than the SSRI drugs When these "work," it is by removing emotional affect entirely. And lithium guarantees irreversible organ damage.

phren0logy 17y ago
While we're talking about science-based medicine: 1. Lithium is a serious medication, but for many people it's their only chance to live life on their terms rather than at the whim of their illness. Some, but not all, experience emotional blunting. 2. Some, but not all, get kidney or thyroid problems. The number increases over time, but it's far from a guarantee. I sometimes prescribe lithium for my patients. I wish there was something unambiguously better out there, but every alternative has issues. It's not the best choice for everyone, but it is the most evidenced-based choice, and the only choice consistently shown to reduce suicide. The best thing I can do for many of my patients is to make absolutely sure they have bipolar disorder (and have a need for one of these medications). The recent rate of growth of the diagnosis is concerning for over-diagnosis.
- DaniFong 17y ago
  "The best thing I can do for many of my patients is to make absolutely sure they have bipolar disorder (and have a need for one of these medications). The recent rate of growth of the diagnosis is concerning for over-diagnosis." Indeed. It is surprisingly hard for medical system to reverse a diagnosis, so what's made first often sticks. (I know this from my own experience, my friend's, and Rosenhan's experiment). And too often bipolar is confused with borderline, or ptsd, or simply depression... this is particularly bad because some of the drugs which work for some of the illnesses instead drastically increase suicidality in others. http://www.gladwell.com/2003/2003_03_10_a_dots.html http://www.gladwell.com/2003/2003_03_10_a_dots.html "In the early nineteen-seventies, a professor of psychology at Stanford University named David L. Rosenhan gathered together a painter, a graduate student, a pediatrician, a psychiatrist, a housewife, and three psychologists. He told them to check into different psychiatric hospitals under aliases, with the complaint that they had been hearing voices. They were instructed to say that the voices were unfamiliar, and that they heard words like "empty,""thud," and "hollow." Apart from that initial story, the pseudo patients were instructed to answer every question truthfully, to behave as they normally would, and to tell the hospital staff--at every opportunity--that the voices were gone and that they had experienced no further symptoms. The eight subjects were hospitalized, on average, for nineteen days. One was kept for almost two months. Rosenhan wanted to find out if the hospital staffs would ever see through the ruse. They never did. Rosenhan's test is, in a way, a classic intelligence problem. Here was a signal (a sane person) buried in a mountain of conflicting and confusing noise (a mental hospital), and the intelligence analysts (the doctors) were asked to connect the dots--and they failed spectacularly. In the course of their hospital stay, the eight pseudo patients were given a total of twenty-one hundred pills. They underwent psychiatric interviews, and sober case summaries documenting their pathologies were written up. They were asked by Rosenhan to take notes documenting how they were treated, and this quickly became part of their supposed pathology. "Patient engaging in writing behavior," one nurse ominously wrote in her notes. Having been labelled as ill upon admission, they could not shake the diagnosis. "Nervous?" a friendly nurse asked one of the subjects as he paced the halls one day. "No," he corrected her, to no avail, "bored."
- Sapient 17y ago
  I don't have have much to add here (downvotes accepted), but I love that this post was made by someone called phren0logy.
  - phren0logy 17y ago
    Yeah, I picked that moniker when I started doing some fMRI research. It's been criticized as "the modern phrenology" so I thought I would l33t it up a bit. The history of phrenology is actually really interesting. Gall made some genuine contributions to science regarding the localization of brain function. It became what we now think of as phrenology, the wild and bizarre pseudoscience, when cranks came crawling out of the woodwork offering simple answers to hard questions and miracle cures in a bottle. Which brings us right back to the OP...
tokenadult 17y ago
lithium guarantees irreversible organ damage Kay Redfield Jamison has been on lithium for a long time and credits it with saving her life. Lithium does have some nasty side effects and not all patients who start with it stay on it. Lithium does need to be used with medical supervision, as its "therapeutic range" is narrow. It is incorrect that patients using mood stabilizing medications lack normal emotional affect. What they are often able to achieve, with differing patients benefitting more or less from differing medications, is freedom from ENDOGENEOUS mood variation unconnected to life events, and a return to the normal functioning of the human mood system as a response to what is objectively happening to the patient. Investigation of long-term treatment effects of lithium on the human brain reported in the primary sources cited in the Goodwin-Jamison textbook http://www.amazon.com/Manic-Depressive-Illness-Disorders-Recurrent-Depression/dp/0195135792/ http://www.amazon.com/Manic-Depressive-Illness-Disorders-Rec... suggests lithium has a neuroprotective effect on brain cells. That is demonstrated by neuroimaging and brain chemistry studies in human beings, by in vitro studies of animal cells, by necropsy studies of animal subjects and by autopsy studies of human beings who die from causes other than mood disorders.

phren0logy 17y ago

While we're talking about science-based medicine: 1. Lithium is a serious medication, but for many people it's their only chance to live life on their terms rather than at the whim of their illness. Some, but not all, experience emotional blunting. 2. Some, but not all, get kidney or thyroid problems. The number increases over time, but it's far from a guarantee. I sometimes prescribe lithium for my patients. I wish there was something unambiguously better out there, but every alternative has issues. It's not the best choice for everyone, but it is the most evidenced-based choice, and the only choice consistently shown to reduce suicide. The best thing I can do for many of my patients is to make absolutely sure they have bipolar disorder (and have a need for one of these medications). The recent rate of growth of the diagnosis is concerning for over-diagnosis.

DaniFong 17y ago
"The best thing I can do for many of my patients is to make absolutely sure they have bipolar disorder (and have a need for one of these medications). The recent rate of growth of the diagnosis is concerning for over-diagnosis." Indeed. It is surprisingly hard for medical system to reverse a diagnosis, so what's made first often sticks. (I know this from my own experience, my friend's, and Rosenhan's experiment). And too often bipolar is confused with borderline, or ptsd, or simply depression... this is particularly bad because some of the drugs which work for some of the illnesses instead drastically increase suicidality in others. http://www.gladwell.com/2003/2003_03_10_a_dots.html http://www.gladwell.com/2003/2003_03_10_a_dots.html "In the early nineteen-seventies, a professor of psychology at Stanford University named David L. Rosenhan gathered together a painter, a graduate student, a pediatrician, a psychiatrist, a housewife, and three psychologists. He told them to check into different psychiatric hospitals under aliases, with the complaint that they had been hearing voices. They were instructed to say that the voices were unfamiliar, and that they heard words like "empty,""thud," and "hollow." Apart from that initial story, the pseudo patients were instructed to answer every question truthfully, to behave as they normally would, and to tell the hospital staff--at every opportunity--that the voices were gone and that they had experienced no further symptoms. The eight subjects were hospitalized, on average, for nineteen days. One was kept for almost two months. Rosenhan wanted to find out if the hospital staffs would ever see through the ruse. They never did. Rosenhan's test is, in a way, a classic intelligence problem. Here was a signal (a sane person) buried in a mountain of conflicting and confusing noise (a mental hospital), and the intelligence analysts (the doctors) were asked to connect the dots--and they failed spectacularly. In the course of their hospital stay, the eight pseudo patients were given a total of twenty-one hundred pills. They underwent psychiatric interviews, and sober case summaries documenting their pathologies were written up. They were asked by Rosenhan to take notes documenting how they were treated, and this quickly became part of their supposed pathology. "Patient engaging in writing behavior," one nurse ominously wrote in her notes. Having been labelled as ill upon admission, they could not shake the diagnosis. "Nervous?" a friendly nurse asked one of the subjects as he paced the halls one day. "No," he corrected her, to no avail, "bored."
Sapient 17y ago
I don't have have much to add here (downvotes accepted), but I love that this post was made by someone called phren0logy.
- phren0logy 17y ago
  Yeah, I picked that moniker when I started doing some fMRI research. It's been criticized as "the modern phrenology" so I thought I would l33t it up a bit. The history of phrenology is actually really interesting. Gall made some genuine contributions to science regarding the localization of brain function. It became what we now think of as phrenology, the wild and bizarre pseudoscience, when cranks came crawling out of the woodwork offering simple answers to hard questions and miracle cures in a bottle. Which brings us right back to the OP...

tokenadult 17y ago

lithium guarantees irreversible organ damage Kay Redfield Jamison has been on lithium for a long time and credits it with saving her life. Lithium does have some nasty side effects and not all patients who start with it stay on it. Lithium does need to be used with medical supervision, as its "therapeutic range" is narrow. It is incorrect that patients using mood stabilizing medications lack normal emotional affect. What they are often able to achieve, with differing patients benefitting more or less from differing medications, is freedom from ENDOGENEOUS mood variation unconnected to life events, and a return to the normal functioning of the human mood system as a response to what is objectively happening to the patient. Investigation of long-term treatment effects of lithium on the human brain reported in the primary sources cited in the Goodwin-Jamison textbook http://www.amazon.com/Manic-Depressive-Illness-Disorders-Recurrent-Depression/dp/0195135792/ http://www.amazon.com/Manic-Depressive-Illness-Disorders-Rec... suggests lithium has a neuroprotective effect on brain cells. That is demonstrated by neuroimaging and brain chemistry studies in human beings, by in vitro studies of animal cells, by necropsy studies of animal subjects and by autopsy studies of human beings who die from causes other than mood disorders.