National institute of mental health workshop report on the treatment of bipolar disorder

The Lithium Ion: A Foundation for Psychopharmacological Specificity

“…Although response rates have varied, they have usually been around 70 or 80%, after a delay of about 1 to 2 weeks for onset of the therapeutic effects (Prien and Potter 1990;Price and Henninger 1994;Calabrese et al 1995). Lithium was found to be at least as efficacious as chlorpromazine for treatment of acute mania in almost all controlled trials (Platman 1970;Spring et al 1970;Johnson et al 1971;Shopsin et al 1975;Takahashi et al 1975;Goodwin and Zis 1979).…”

“…Early placebo-controlled studies (Baastrup et al 1970;Coppen et al 1971;Cundall et al 1972;Dunner et al 1976;Fieve et al 1976;Hullin et al 1972;Prien et al 1973aPrien et al ,b, 1974Stallone et al 1973) corroborated that. The effectiveness for bipolar disorder prophylaxis is well documented in double-blind controlled trials, both for the manic and depressive phases of the disorder (Prien and Potter 1990;Price and Henninger 1994;Calabrese et al 1995).…”

“…The differential outcome in the group of bipolar versus schizoaffective disorder patients was not reported. The report of the National Institute of Mental Health (NIMH) workshop on the treatment of bipolar disorder (Prien and Potter 1990) suggested that lithium is overall ineffective in 20-40% of bipolar patients, particularly those with rapid cycling or dysphoric mania.…”

Myth of evidence-based medicine for bipolar disorder

“…These difficulties are compounded by the paucity of studies in the area of bipolar illness in general and compared with other major psychiatric disorders such as schizophrenia [15,16]. Yet, guidelines touting evidence-based approaches to clinical therapeutics typically overvalue and give the highest strength of support grade to information derived from the traditional RCT with a placebo parallel group design.…”

“…Such an educational effort is more easily said than done [15,16]. A tightly designed placebo-controlled clinical trial will almost always get much higher ratings for scientific excellence than a desperatelyneeded comparative clinical trial of the effectiveness of two different approaches to clinical therapeutics.…”