Lithium works best narcotic in reducing self-harm and suicide, and bad reputation is misplaced, examine suggests
Britains 650,000 people with bipolar disorder should take lithium to assist control their condition, despite its reputation for dulling the senses, a significant new examine has found.
Researchers claim that although the narcotic does carry some health risks, its overall effectiveness, especially its ability to reduce self-harm and suicide, mean it was necessary to much more widely used.
The findings are contained in the first analyse comparing the side-effects of the four main mood-stabilising narcotics the NHS prescribes. They have inspired calls for a rethink about attitudes towards lithium, given that only an estimated 10% of those with bipolar disorder utilize it, principally because patients fear it will cause loss of personality, weight gain and other problems.
The lead author behind the research told the Guardian that widespread lithium stigma among patients is leading to them receiving the wrong therapy and ending up admitted to hospital unnecessarily because their condition is not as well controlled as it could be.
Lithium is a drug with a bad reputation. It is considered by patients, and some psychiatrists, as a dangerous drug. People rightly have suspicions about it. Patients say that the downsides include emotional numbing feeling that you arent connected with your impressions as well as tremors, said Dr Joseph Hayes, a psychiatrist at University College London.
But lithiums reputation is largely misplaced and based on the experiences of patients from the 1960 s to the 1980 s who were given too large a dosage of the medication, he added. The new research, published in the medical periodical PLOS Medicine, found that the side-effects of the mood-stabilising alternatives used by most patients are either the same as or worse than lithium, Hayes said.
The paper, co-written by Hayes and four colleagues from UCL and Oxford University, concluded that: Lithium remains an important therapy for individuals with bipolar disorder. It accepts that there is clear evidence that its use is associated with a number of adverse events.
However, it adds: These hazards need to be offset with the potentially superior effectiveness and anti-suicidal benefits of the drug compared to other therapy options.
The researchers studied a nationally representative sample of 6,671 patients across the UK who were treated for bipolar disorder between 1995 and 2013. Of those, 2,148 had taken lithium, 1,670 had used valproate, 1,477 had been on olanzapine and 1,376 had taken quetiapine. They experienced side-effects including chronic kidney cancer, thyroid cancer, weight gain and high blood pressure.
The researchers analysis out one of the two main criticisms of lithium, but saw the other to be baseless. They found that patients on lithium had a higher risk of suffering kidney function problems and developing hypothyroidism or hyperthyroidism and also hypercalcemia. However , none of the medications caused more severe kidney problems.
Meanwhile, lithium patients were less likely to put on weight than patients on the other narcotics. While 15% -2 0% of those on the three other narcotics were more likely to gain more than 15% of their body weight, only 10% of those on lithium put one across the same sum of extra pounds. Those on olanzapine added the most weight and experienced high blood pressure as a result.
Separate research has shown that patients on the other three medications are 40% more likely to harm themselves than those on lithium. Bipolar disorder carries one of the highest rates of suicide of any mental illness, alongside schizophrenia and alcohol and drug addiction.
The very limited use of lithium is despite the National Institute for Health and Care Excellence( Nice) advising in 2014 that it should be the standard treatment for bipolar disorder, which is also known as manic depression and is characterised by manic highs and bouts of depression. That supplanted its previous opinion, outlined in 2006, that any of the four drugs were useful first lines of therapy for the condition, which affects about one in 100 people.
Lithium stigma, which includes some people in the psychiatric community, have contributed to people using drugs that are less effective[ than lithium ]. To me as a doctor thats a big worry because my main aim is to help people to be well and if you arent doing that with the best available evidence then you are failing patients, said Hayes.
I think that many patients are missing out quite commonly on the best available therapy. That means that people end up in hospital more often than they need to and end up attaining reductions in “peoples lives” than they could do if they were on lithium. The high suicide rate with bipolar disorder should encourage greater employ of lithium. There should be more sensible employ of it.
Stephen Buckley, head of information at the charity Mind, said: We greet research which adds to our understanding of treatments and drugs for people experiencing mental health problems, including bipolar disorder. But as with all areas of mental health there is still more research to be done.
Different people will find that different treatments help with managing their own mental health problems. This may be drug, talking therapies, or a mixture of both.
Read more: www.theguardian.com