The homeopathic treatment of bipolar is unethical and dangerous

I'm with Jane. I have been planning to write this post for about a year. It has taken me this long to calmly put words to paper, as the topic of this article is sensitive for those of us who know someone, or who themselves, suffer from bipolar disorder.

About ten months ago, a naturopath by the name of Dorothea Cist commented on my article about ND education and training, claiming:

I have many other cases of, and letters of testimony from, patients who were treated successfully by naturopathic medicine, and often by homeopathy alone. These magnificent cures, by treatments completely unsupported by any double-blind, placebo-controlled clinical trials, were from pathologies as varied as rheumatoid arthritis, ulcerative colitis, grand mal seizures, interstitial cystitis, and bi-polar [sic] disorder.

I asked Cist to clarify. Is she claiming she can cure bipolar disorder with homeopathy?

She didn’t respond, but she didn’t need to. Yes, Cist was asserting she can use magic to cure a mental illness, along with a slew of other complicated diseases.

Statements like Cist’s infuriate me. And they also break my heart. I am sad for the patients, and their families, who have fallen prey to false claims regarding the safety and efficacy of treating mental illness with naturopathy and homeopathy. Naturopaths are terribly under-qualified to treat mental illness.

I happen to know several people with bipolar disorder. One of these people is very close to me. I have held her hand and wiped away tears while listening to harrowing tales of mania, suicidal ideations, and depression. I have been privy to the fear, the anger, the delusions, and the hopelessness that often accompanies bipolar disorder. I am in awe of my friend everyday, who bravely gets up, takes her medication, and carries on, despite the enormous challenges that lie ahead for her.

If there was a cure as simple as homeopathy, high-dose vitamins, or diet changes, trust me, my friend and I would pursue it. But bipolar management is far from simple, and homeopathy will never cure any disease.

A disease with no cure

There is no such thing as a cure for bipolar disorder. There is only bipolar disorder management. The evidence is clear on this point: bipolar disorder is a life-course illness that is managed best with the help of a qualified medical physician and psychiatrist. The exact causes of bipolar have not yet been pinned down. We know multiple factors contribute to the disorder. The specific combination of these factors likely differ person to person. And, genetics probably play a big role in the cause. [1, 2, 3] Given the lack of knowledge around the cause, it makes sense no cure exists.

More often than not, medications offer bipolar patients relief from the disease’s troublesome  symptoms, which include alternating episodes of mania and depression, delusions, insomnia, anxiety, and migraines. The use of herbs and diet to control these symptoms is not well-researched, and generally not recommended by leading organizations, such as the National Institute for Mental Health. Certain herbs and nutrients can trigger mania, such as St. John’s Wort or 5-HTP (an intermediate in the serotonin pathway.) Since we still do not understand the effects of combining pharmaceutical medication with herbal supplements and high-dose vitamins, it is safest to avoid these combinations. Even seemingly benign therapies, such as fish oil, have had mixed results for patients with bipolar. [1, 2, 3]

I was surprised when I could not find unambiguous statements from reputable medical organizations that could help steer bipolar patients away from alternative medical therapies for disease management. Of all the websites I perused, Mayo Clinic offered the most straight-forward and clear advice: [4]

Don’t stop taking your prescribed medications or skip therapy sessions. Alternative medicine is not a substitute for regular medical care when it comes to treating bipolar disorder.

Be honest with your doctors and mental health providers. Tell them exactly which complementary treatments you use or would like to try.

Be aware of potential dangers. Just because it’s natural doesn’t mean it’s safe. Before using alternative or complementary medicine, find out the risks, including possible interactions with medications.

This is a good start. But I’d really like to see a stronger statement that gets to point about using naturopathic, specifically homeopathic, treatments for bipolar disorder. Let me be the first.

No natural remedy, including vitamins, herbs, dietary changes, or energetic therapies such as homeopathy, has been clinically proven to be safe and effective for managing bipolar disorder. It is strongly recommended that patients suffering from bipolar disorder make treatment decisions with the help of a qualified medical physician and psychiatrist. In the interest of your well-being and safety, please do not employ a naturopath and/or homeopath to assist in your treatment, as these providers are not adequately trained to diagnose or manage mental illness.

I was not aware of bipolar disorder until college, when two acquaintances each committed suicide, just a few months apart, after quietly struggling for years with the disorder. My childhood acquaintance took his life violently, characteristic of most men attempting and/or committing suicide. My girlfriend from college also chose a gender-based stereotypical method; she overdosed on Tylenol. [5,6]

These incidents were seminal in my life. After they occurred, I was very sad, but also very curious about bipolar disorder and what drives these patients to the brink of suicide, and often over the edge. Seeking answers, I turned to the book An Unquiet Mind: a memoir of moods and madness, written by Kay Redfield Jamison, PhD.

A literary description of bipolar

Dr. Jamison is a clinical psychologist who also suffers from bipolar disorder herself. She was diagnosed with the disorder as a young adult. Since this time, she has written extensively about her personal experiences with the disorder, and its treatment. In her 1995 memoir detailing her personal struggles with bipolar, she describes mania like this:

There is a particular kind of pain, elation, loneliness, and terror involved in this kind of madness. When you’re high it’s tremendous. The ideas and feelings are fast and frequent like shooting stars, and you follow them until you find better and brighter ones. Shyness goes, the right words and gestures are suddenly there, the power to captivate others a felt certainty. There are interests found in uninteresting people. Sensuality is pervasive and the desire to seduce and be seduced irresistible. Feelings of ease, intensity, power, well-being, financial omnipotence, and euphoria pervade one’s marrow. But, somewhere, this changes. The fast ideas are far too fast, and there are far too many; overwhelming confusion replaces clarity. Memory goes. Humor and absorption on friends’ faces are replaced by fear and concern. Everything previously moving with the grain is now against– you are irritable, angry, frightened, uncontrollable, and enmeshed totally in the blackest caves of the mind. You never knew those caves were there. It will never end, for madness carves its own reality.

As for suicidal ideations, Jamison writes:

If I can’t feel, if I can’t move, if I can’t think, and I can’t care, then what conceivable point is there in living?

Reading these excerpts again, I can make sense of the pain and the fear present in bipolar patients. I can understand the desire for simple treatment answers. I can also see how patients, possibly in the midst of a manic moment or dark depression, could be swindled into believing that something energetic, like a “vital force” said to be present in ourselves and the universe, is the answer to ridding them of all their suffering. In fact, mania is hallmarked by impulsive and often irrational decision-making along with extravagant ideas and beliefs. Delusions are common, and can accompany hyper-religiosity, grandeur, or feelings of persecution. [1-4] In this context, it seems relatively easy for naturopaths to successfully persuade manic-depressive individuals to denounce the evils of Big Pharma and to believe in “the healing powers of nature.”

Jamison is an outspoken advocate for pharmacological intervention and psychotherapy as the best, and only, approaches for effectively managing the symptoms of bipolar disorder. Anything else, Jamison argues, is dangerous and life-threatening for the bipolar patient. This seems stark, but it is estimated that anywhere from 25% to 50% of bipolar patients will attempt suicide at least once. The drug lithium (derived from the naturally-occurring chemical element for which it is named) remains the “most demonstrably effective treatment against suicide” in bipolar patients. [5-7]

Despite her resolute stance on pharmacological intervention as part of responsible bipolar management, Jamison understands the desire to find cures and answers in something other than a pill. She says,

No pill can help me deal with the problem of not wanting to take pills; likewise, no amount of psychotherapy alone can prevent my manias and depressions. I need both. It is an odd thing, owing life to pills, one’s own quirks and tenacities, and this unique, strange, and ultimately profound relationship called psychotherapy.

Years after reading this book, my dear friend (let’s call her Jane) was diagnosed with bipolar disorder. I was already well into my naturopathic cult phase when the diagnosis came. Thankfully, Jamison’s words stuck with me. I knew we needed medication on board, and the skills of a psychiatrist. Even though I was a naturopath, I knew that no naturopathic therapy could effectively or safely manage bipolar’s mania and depression. Perhaps this was because I had already seen the devastating effects of bipolar illness. Or maybe the writing was already on the wall regarding my future relationship with naturopathy. Regardless, steering my loved one away from naturopathy and toward real medical care was one of my best acts as a naturopath. Surprisingly, not everyone felt that way.

“Go Hug a Tree”

I was taken aback by the amount of social villainization Jane experienced after the diagnosis of bipolar. The problem for Jane’s peers was not the fact that she had bipolar disorder; it was how she was choosing to treat bipolar with lithium and lots of therapy, that caused problems.

Given our draw to naturopathic woo, I was surprised that Jane was receptive to my recommendation that she avoid naturopathic care for bipolar disorder. After planting the seed, I equipped her with a copy of Jamison’s book. Jane devoured the book in a matter of hours. She called me crying, “I feel like Jamison is narrating my life.” I was weirdly happy about this. This meant Jane was going to follow Jamison’s advice, and start medication. And she did.

Shortly after starting lithium, Jane began to feel significantly better. Yes, the lithium had side effects; most of them still persist. Jane suffers from severe dry mouth constantly. She gets headaches and experiences dehydration and nausea from time to time. But this cost, she says, is worth the treatment.

I remember her describing the experience of starting lithium as a feeling of gaining control of her life again. She knew she would likely be on lithium forever, or for as long as possible given the long-term side effect of kidney failure, but this was okay, because she now had a future she could believe in and plan.

Feeling good about starting the appropriate treatment stopped short for Jane when a fellow “friend” and believer in naturopathy suggested Jane was poisoning her body with lithium. This friend went so far as to say that Jane actually didn’t suffer from bipolar at all, because the disease doesn’t really exist. This diagnosis was a way for pharmaceutical companies to take advantage of patients and brainwash them into thinking they need medication for life. In reality, this friend proclaimed, Jane was just out of touch with nature. Her chakras were off. The only treatment necessary was to get outside more and hug a tree. While shocking, I can see how a naturopathic devotee would believe such nonsense.

For some inexplicable reason, naturopaths, like Dorothea Cist, believe they are qualified to treat mental illness. Naturopathic students at Bastyr do take a course called “Addictions and Disorders,” which touches on a variety of mental illness disorders. The course was taught by someone pursuing her PhD in psychology (I think). As many readers know, I also took one class in pharmacology. We may have covered the prescribing and management of anti-psychotic drugs and others, like lithium. I’d have to comb through my notes to know for certain. But I don’t need to do this. Any reasonable person understands that one class in mental health, followed by one class in pharmacology, does not make a provider competent in mental health care. To claim otherwise is preposterous.

On the other hand, naturopaths have extensive training in homeopathy. Students spend far more time memorizing remedies and homeopathic keynotes compared to learning drug names, dosing schedules, and medical indications. Some of the best homeopathic keynotes allude to mental illness, such as: (homeopathic remedy listed in parentheses) [8]

  • Hysterical personality who longs for amusement (Sumbulus)
  • Haughty, ungrateful, and easily bored philosopher, who hates changing his clothes or washing them (Sulphur)
  • Extremely nervous and restless personality; lack of concentration; tantrums; hard to convince that her ideas are unrealistic (Tantal)
  • Sensitive to the slightest touch; if it was possible, he would wear nothing; friendly person who lets his dog howl instead (Anthrax nosode)
  • Simple minded and very shy person, who suffers from severe memory problems and should never be forced to pick up the phone (Ambra)
  • Mentally confused and very irritable person with persisting thoughts and suffering from weary and swollen feet (Aesculus hippocastanum)

Perhaps this is why so many naturopaths feel they are qualified to treat mental illness using homeopathy.

For example, the licensed naturopaths Mark Janikula and Brooke McNeal at Fountainhead naturopathic mental health clinic in Santa Cruz, CA, claim their own “innovative” system of treating bipolar is superior to the care offered by real medical professionals. They use homeopathy followed by other “supportive therapies” to help the homeopathy work better. As for medication, they hope to take patients off of their bipolar prescriptions altogether.

Using an old system of debunked medicine to cure mental illness hardly calls to mind innovation. It seems far more archaic, in my opinion, to let the patient suffer, when there are real and effective treatments at hand. I am also fascinated that the naturopathic/ homeopathic treatment plan doesn’t mention counseling, which is a mainstay of naturopathic care.

These folks are not the only licensed charlatans offering magical pills and high-dose vitamins (commonly called orthomolecular medicine) for bipolar disorder. There are many other examples, easily accessed via a Google search.

Tara Peyman writes about homeopathy for bipolar disorder in Natural Healing News and markets herself as an expert in bipolar treatment on her practice website. Her practice is located in Scottsdale, AZ.

Jennifer Bahr promotes herself as an integrative mental health care specialist in Del Mar, CA. I fail to see the integrative aspect of her care, as she primarily uses homeopathy to treat bipolar, which she describes as “the most comprehensive medicine available.” Providing homeopathic care for mental illness is not integrative. It is care-less. But Bahr really shows off her ineptness when she describes bipolar disorder as “a disorder of the circadian rhythm.” I am left speechless.

Final thoughts

I am not arguing that the current evidence-based treatment protocols for managing bipolar disorder are perfect. They are not. This is precisely why there is a market for alternative bipolar therapies. But the shortcomings of pharmacology does not mean we should allow outright unethical practices, like using homeopathy to “cure” bipolar, to persist. Patients’ lives are literally at risk.

I have learned a great deal about bipolar disorder over recent years while experiencing so much of it through the eyes of Jane. From time to time, she gets sick of taking pills, and questions about naturopathy resurface. Should I see a naturopath for dietary advice? Should I consider this supplement? The answer is always the same: no. Thankfully, she (tends to) listen to me.

I am expecting to get slammed for this article. I am going to hear critiques about psychiatry, in general. Many readers have written to me stating they believe that the fields of psychology and psychiatry are quackery, and will I write about these fields, too? (No, I won’t.) I have also heard many arguments that psychiatric intervention involves the swapping of drug side effects for mental illness symptoms. These folks argue that simply “medicating away” mental symptoms is not real treatment.

Fine. But here is the key difference for me, distilled down perfectly by Jane. One group of symptoms, specifically the drug side effects, are annoying and bothersome, but tolerable given the tremendous benefit. The other group of symptoms, which include delusions, dangerous behaviors, suicidal thoughts, and depression, are not. She’d rather risk kidney failure due to lithium, than risk her life due to bipolar disorder.

I’m with Jane. The risks associated with bipolar are too great to not demand anything but the safest, most effective medical care. In the interest of doing no harm above all else, naturopaths should be prohibited from treating bipolar disorder.

I’d give anything to keep Jane, and others like her, safe. I’ll take this heat for this blog post. And if the time ever comes, I’ll give her a kidney. Keeping her away from quackery is worth more than an organ. It’s worth her whole life.

References:

  1. National Institute of Mental Health. https://www.nimh.nih.gov/health/topics/bipolar-disorder/index.shtml#part_145406 Accessed 31 Mar 2016.
  2. National Alliance on Mental Illness. https://www.nami.org/Learn-More/Mental-Health-Conditions/Bipolar-Disorder Accessed 31 Mar 2016.
  3. WebMD.com http://www.webmd.com/bipolar-disorder/guide/bipolar-diet-foods-to-avoid Accessed 31 Mar 2016.
  4. Mayo Clinic. http://www.mayoclinic.org/diseases-conditions/bipolar-disorder/basics/alternative-medicine/con-20027544 Accessed 31 Mar 2016.
  5. Schrijvers, Didier. “The gender paradox in suicidal behavior and its impact on the suicidal process”. Journal of Affective Disorders 138 (2): 19–26. doi:10.1016/j.jad.2011.03.050.
  6. Varnik, A; et al. “Suicide methods in Europe: a gender-specific analysis of countries participating in the European Alliance Against Depression. Journal of Epidemiology and Public Health 62 (6): 545–551. doi:10.1136/jech.2007.065391
  7. Baldessarini, R. J., & Jamison, K. R. (1999). Effects of medical interventions on suicidal behavior. Summary and conclusions. The Journal of Clinical Psychiatry, 60 Suppl 2, 117–122.
  8. Jamison, K. R. (2000). Suicide and bipolar disorder. The Journal of Clinical Psychiatry, 61 Suppl 9, 47–51.
  9. Simpson, S. G., & Jamison, K. R. (1999). The risk of suicide in patients with bipolar disorders. The Journal of Clinical Psychiatry, 60 Suppl 2, 53–56; discussion 75–76, 113–116.
  10. Miller, G. (2014). 333 Homeopathic Keynotes composed in Twitter Style. Books on Demand GmbH. Excerpts retrieved from https://goo.gl/Bck3vE Accessed 31 Mar 2016.