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Is lithium an appropriate treatment for bipolar disorder when an individual can't give informed consent?

Beginning in the 1950's lithium was the "gold standard" for the treatment of bipolar disorder. Then in the 1980's and 1990's studies began to appear that connected long-term lithium usage with renal failure requiring, eventually, dialysis and/or a kidney transplant.

Should a bipolar individual be informed that their preferred treatment might result in renal failure when that knowledge might result in the individual declining treatment? Can a mentally ill individual give informed consent when it comes to their treatment?

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    Oct 5 2012: Bipolar disorder is a serious condition which, if I understand this correctly, is experienced differently by different people. I do not know whether the variations are explainable by a person's biology, personality, or life circumstances.

    The different ways the condition plays out, plus the risk of suicide, suggest that there is no one-size-fits-all best prescription for controlling the problem and that anyone who needs to make a treatment decision for himself or loved ones should get multiple expert opinions.
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    Oct 5 2012: Having Bipolar Disorder myself, I've established an advanced health care directive (also known as a living will) with my family members. If my condition were ever to reach to point where I am no longer able to make my own informed decisions regarding my mental health care, the advance directive gives my family the legal power to make those decisions for me.


    If there is no advance directive, and it's determined that the patient is not mentally sound, then he or she becomes a ward of the state, and a judge will make the final treatment decision.
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    Oct 5 2012: No, don't do it the psych drugs are a one way ticket, once they start they will never be able to stop.
    • Oct 5 2012: Again you display an astonishing ignorance of humanity, Pat. For those struggling with a mental health issue as utterly treatable as bipolar disorder to be told to avoid drugs because they'll ever be able to stop is tragic. It is like telling a diabetic to avoid insulin because, gosh, once they start that stuff they'll have to take it their entire lives.

      Bipolar is a painful disease for those who live with it. It responds very well to medication and they are working on getting better and better meds. Yes, the side effect of long term lithium use is bad. The side effect of uncontrolled bipolar disorder is worse.
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        Oct 5 2012: Right back at you

        Your analogy to insulin is apples to oranges.

        My anecdotal experience with Psych drugs in general are of being given Ritalin as a kid with detrimental effects. And a relative who has been on lithium for decades. Who when he quits taking it for whatever reason has to be put in the rubber room, literally. The danger is not so much renal failure as instant insanity. Not to mention the high incidence of violence associated with the drugs, Columbine, Virginia Tech, Aurora, etc.

        The scary thing is that psychologists have a huge percentage (20%) of the population on this poison.
      • Oct 5 2012: Personally, I disagree. I'd rather have healthy kidneys and decompensate every few years than face the potentially horrific effects of long-term dialysis. You would have me believe that trading physical health for mental health is a choice every "sane" person would make. The primary reason you might be right is not the impact on me, but on the impact on my family. Frankly, the hypomanic episodes tend to be enjoyable.

        No one ever told me that there were alternatives to lithium that did not have the side effect of potential renal failure. Now that I am beyond the statute of limitations, I have no legal course and will probably lose my house and inheritance just to pay for dialysis which can run up to $80,000/year. My insurance won't cover much of the cost and Medicare only pays 80% when I reach age 65.
        • Oct 6 2012: Decompensation "every few years" is different from what many people suffer through. Additionally, the hypomanic episode's enjoyment is part of the problem. For one the episodes are not usually enjoyable for your family and are often expensive and take months if not years to pay off.

          I am sorry for you and your kidneys. The meds are getting better and more fine tuned these days and much of that improvement was at your expense.... I do not however think that all who take bipolar meds wold agree with you on the cost benefit analysis.