Friday, May 11, 2007

Subthreshold Bipolar: Media Blitz and Lilly

I posted in lengthy form yesterday about the newly legitimated "subthreshold" bipolar disorder (hereafter referred to as SBD) that 2.4% of Americans allegedly will develop during their lifetime. The press releases and "news" stories have predictably followed. Let's start with something called Medical Condition News. Prepare for some bad journalism...

The headline reads as follows: "4 percent of US adults have some form of bipolar disorder"

Sure, a newly minted disorder (SBD) that actually appears nowhere in the official diagnostic manual accounts for most of that, but whatever.

Here's how the news piece characterized SBD:

...a milder, sub-threshold bipolar disorder that involves hypomania with or without depression, otherwise classified as bipolar disorder "not otherwise specified" in the current diagnostic nomenclature of the American Psychiatric Association.

Except that SBD did not require hypomania -- SBD actually required more like half of hypomania. Note to journalists: Read the article, then write on it.

How about treatment? Here's what the article said:

However, over the previous 12 months, only 25 percent of those with bipolar disorder I, 15.4 percent with bipolar disorder II and 8.1 percent with sub-threshold bipolar disorder received appropriate medication

Remember, there is scant if any research on what appropriate medication is for bipolar II and there is not a damn bit of research attesting to medication for SBD. Remember, the article said that appropriate medication included mood stabilizers, antipsychotics, and lithium. Who cares that this is just pulled out of a hat?

Article 2
This one has appeared on a few different sites. Duck and cover.

However, only a few [who current were in an "episode"] received appropriate medication (25.0% for bipolar I, 15.4% for bipolar II, and 8.1% for subthreshold bipolar disorder). Appropriate maintenance medication for currently asymptomatic patients was even lower (17.9%, 15.6%, and 3.2%, respectively).

Again, this is suggesting that there is an appropriate medication treatment for bipolar II and SBD, when the data just ain't there. If the mainstream press jumps on this, this could be a big problem.

The Zyprexa Connection
The rich irony of this is that Lilly has been shamed by the disclosure of internal documents (like this one) showing that it pimped Zyprexa to primary care doctors for a condition similar to SBD. Apparently Lilly was just ahead of their time. Lilly must be shaking their heads -- they get negative media coverage while researchers have now just sneakily endorsed the treatment of watered-down bipolar disorder with... drugs like Zyprexa. Please read my earlier post to see how this all ties together. There was no science behind the treatment for faux bipolar when Lilly was offering it, and there is still no science behind it today.


Anonymous said...

The pharmas and the psychiatrists and many academic researchers see how well they are doing financially by turning classical autism, childhood schizophrenia, Asperger's and PDD, and mild autism etc. into the not so mysterious epidemic of ASDs. So they figure why not go for it and expand Bipolar in a clever way to sell more drugs and have the government and patient advocacy groups they set up fund more useless research. Who is to stop them?

Anonymous said...

My predictions: treatment will be helpufl for pharmaceutical stocks and will cause patients to gain a lot of weight.

CL Psych said...

Dr. X -- I'd argue if I could. I think you're right.

Anon -- I think it's true that many mental states lie on some sort of spectrum. But the dividing line where treatment is considered appropriate seems to be constantly sliding toward including more and more people. And when AstraZeneca is helping to prepare these allegedly independent manuscripts which pimp treatment for SBD, ducking and covering may be in order.

Once SBD runs out of momentum, what will be next?