Tuesday, February 10, 2009
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Cyclothymia and pharmacological treatments: What is truth?
David Healy wrote in the New Scientist (see my previous post and translation in Courier International). : "labs, often with the enthusiastic support of psychiatrists, managed to embed deeper into the minds
the idea that these disorders (mood) require preventive treatment for life, not just when the onset of manic or depressive episodes. It can read on the site Bipolar Help Center Eli Lilly that is "vital to follow a long-term treatment. Without medication, the symptoms recur and the disease will worsen. "
(...) But there are a lot less evidence than is to support these assertions. And the few that are available do that the most severe form of the disease. [Bipolar disorders are classified into two categories: Type I and II, from the lowest to lighter, limits and shapes called cyclothymic disorder.] Data are lacking almost entirely on the type II or cyclothymia since Clinical trials have mostly been carried out on people with bipolar disorder type I. Yet they represent only one tenth of the cases.
This excerpt from the translation of the article by David Healy inspired me to do a little investigation so I spent part of my morning look at the results of scientific the BPII and cyclothymia PubMed (Over 650 entries for cyclothymia!).
A Canadian study of 2004 (Department of Psychiatry, University of British Columbia, Vancouver) caught my attention: "Pharmacotherapy of bipolar II disorder: a critical review of current evidence":
http://www.ncbi. nlm.nih.gov/pubmed/14996137
which concludes: "there is a paucity (lack) of sound evidence to help guide clinicians Treating BP II patients. Decisions about pharmacotherapy Should Be Made on a case-by-case BASIS; list overall, broad recommendations are based is available That Can not Be evidence adequately made. More Quality Research Needed to SI delineata Effective Treatment Strategies ".
Then I stumbled on this very serious U.S. study of 2007 (" Case Western Reserve University staffed by a specialist in BP II and cyclothymia, Dr. Calabrese) regarding the effectiveness of Divalproex Sodium (Depakote) in adolescents and cyclothymic BP II over a period of 5 years:
Double-blind, placebo-controlled trial of divalproex monotherapy in The Treatment of symptomatic youth at high risk for Developing bipolar disorder.
http: / / www.ncbi.nlm.nih.gov/pubmed/17503990?ordinalpos=5&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum
which the conclusion is "no significant improvement with regard to the results": "These results Suggest That, although well Tolerated, divalproex sodium Does not Produce Clinically Meaningful Improvements in The Treatment of symptomatic Youths Suffering from bipolar NOS Either Gold Cyclothymia Who are at genetic risk for Developing bipolar disorder. "
To compare these tests with the University of Texas more conclusive but over a period of 8 weeks:
An open-label trial of divalproex in Children and Adolescents With Bipolar Disorder.
http://www.ncbi.nlm.nih.gov/pubmed/12364844?ordinalpos=15&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum
which concluded that the Depakote is "safe" and effective for young people: "This study Provides Preliminary support for The Safety and Effectiveness of divalproex in The Treatment of Bipolar Disorder in Youth."
According to a psychiatrist with whom I had contact in Canada, a study will shortly be published on the efficacy of Seroquel (quetiapine) for adults BP II (but not cyclothymic).
Healy seems to be right when he says there is a lack of "evidence" for the results over the long term (I am not an expert but only studies over several years can provide guidance for prophylactic treatment) and laboratories on the right in general psychiatry (
http://pharmacritique.20minutes-blogs.fr/archive/2009/02/07/le-rapport-de-l-igas-nous-donne-une- idea-of-conflict-of-inte.html
# more) that have a vested interest in selling you the prophylactic treatment, "for life". We certainly understand that pharmacological treatments are necessary and vital for the episode (manic or hypo, mixed state or severe major depression). But after settling what to do? Say 1 year later? I do not quite agree with David Healy on the current trend of "Buypolar" as cyclothymia and BP II and cyclothymia are a reality and psychological suffering of attenuated bipolar is real except that one would wonder more and more to where to turn for treatment (and even for the diagnosis) because between the negation of the Bipolar Spectrum still very common and the excesses of " Buypolar "(abuse of drugs and sometimes as diagnostic for depression). Where is the Via Media?
Until there are no guidelines, protocols for specific treatments, it remains unclear and the subjectivity of the physician or psychiatrist.
us back to the main question: what about bipolarity does one and cyclothymia what? What criteria: Felt the patient or external criteria: suicidal thoughts or attempts, "" hospitalization "," substance abuse ", etc. ...?
It seems clear that many cyclothymic need treatment. Which? Psycho-education alone or with medications? And especially for how long?
Experts cite surveys, studies, tests? But what is the validity of these studies and can attest to that?
Regarding children and adolescents, caution is also needed especially when experts in child psychiatry at Harvard forget to declare their earnings from laboratories (
http://www.nytimes.com/2008/ 06/08/us/08conflict.html
), when a professor of neurology at the University of Florida warns against the effects of anticonvulsants on children: Judith Warner http://www.psychiatrictimes.com/display/article/10168/52286 or when concerned psychiatric medications that are given to children so-called "difficult" ... http://warner.blogs.nytimes.com/2008/11/20/tough-choices-for-tough-children/
Should we follow the advice of the Canadian study of 2004 pre-quoted? : "Broad recommendations are based is available That Can not Be evidence adequately made. More research quality IS Treatment Needed to delineata effective strategies." Where
ask for more explanations and evidence of the effectiveness of treatments, which have, let us recall, side effects are not negligible. It is true that lithium and Depakote have a marketing authorization in France and have long been used in psychiatry, but is there any data? And a sufficient basis for BP II and cyclothymic?
In Britain, the National Institute for Health and Clinical Excellence, which advises the National Health Service has published a "guideline" to mild depression. (
http://guidance.nice.org.uk/CG90/NICEGuidance/pdf/English
). This institute is independent (not funded by the labs) and it seems that the option des médicaments n'est pas la première ...Comme c'est étrange. (Bas de la P. 21) "Use of antidepressants" :
Antidepressants are not usually recommended
for people with mild depression. But they may
help you in certain circumstances – for example,
if your depression has lasted a long time, or if
you have had severe depression before and now
have milder symptoms.
La question est moins claire lorsque le guideline dit :
The severity of depression varies a great deal.
Some people have only a few symptoms, which
affect daily life in a limited way. This is called
mild depression. Other people may have more
symptoms That CAN make daily life very difficulty - This Is Called
severe depression.
What then? The tolerance for the suffering of each varies and as pointed out very wisely Charles Barber, which is important is not the degree of pathology of the disease but the resources with which the person faces. Again, what matters is mainly the external criteria and objectives: hospitalization, suicidal thoughts, inability to have a normal social life, etc. ... I will go further to say that personality is more than the temperament critical: a good person surrounded, which keeps morale, with values and principles, practice a sport that is feeding well and has every chance to control many features of cyclothymic. It is a long-term, difficult and sometimes resulting in human sacrifices, but grew up in spring and confidence and the sense of "temperament excessive" cyclothymic becomes a reality.
In my case, some psychologists told me I could do without drugs, others were recommended to me, others told me I could do what I wanted. Brief in doubt I abstained and I intend to abstain until I do not have significant episodes or as long as I do not really feel the need. I'm not opposed to taking drugs in principle but the decision must be considered and intervene in some cases ("case-by-case" as concluded in the Canadian team). Meanwhile, I am using my little creativity Kafkaesque reduction and it works so far (p.73 and 239 of Cyclothymia for the worse and best). I find it reasonable that if cyclothymia "Calvinist" or "horacienne" that requires us to be simple, humble, submissive to God or to nature and away from the temptations of ambition.
The patient tomorrow, if he wants to be free and critical, will be "the expert himself" and make their choice according to the psychiatrist, psychologist or social worker, who will act as "consultants".
Please give me some scientific information (BPI studies versus BP II and cyclothymia) on this or additional suggestions.
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