Experimental Chimp

This is one of the more irresponsible things I’ve seen recently:

Lithium. As a dietary supplement.

Lithium is a - perhaps the - mood stabiliser used in the treatment of bipolar disorder. It’s been used to treat mania since the 1970’s and is widely prescribed today. People who have been prescribed lithium usually have regular blood tests, because too much lithium can cause kidney damage and do bad things to the thyroid. Lithium’s useful and has saved lives, but it’s not a drug that should be treated lightly.

So how come it’s being sold like a multi-vitamin?

Oh, Dr. Nieper

For the answer we have to go back to the 1970’s and a German doctor called Hans Nieper. Nieper, who died in 1998, was known for his controversial methods of treating cancer, multiple sclerosis and heart disease. using large doses of vitamins, minerals and various extracts, he theorised that combining drugs with specific acids - which he called “mineral transporters” - could more effectively deliver the drug in the patient’s body.

Many drugs need to be in the form of a salt to be stable. Lithium, the kind that actual doctors prescribe, is usually in the form of lithium carbonate. The lithium molecule is combined with a molecule of carbonic acid, to form lithium carbonate. It would be unwise to take pure lithium as adding lithium to water results in what chemists like to call a “brisk exothermic reaction”. To put it another way, you’d end up with no tongue.

The orotate form of lithium replaces the carbonic acid with orotic acid. Nieper believed that combining a mineral like lithium with orotic acid would mean that the drug would be released only inside cells. His own description of this process can be found here.

Saying that Nieper’s approach is outside the mainstream is a little like saying that Las Vegas is on the outskirts of New York. In 1990 the US Office of Technology Assessment prepared a report for Congress on unconventional cancer treatments. Four years before, the FDA had banned the importing of drugs produced by Dr. Nieper:

More than 75 misbranded and unapproved drugs prescribed by Nieper have been detected in mail and personal baggage importations. These are directed to patients who may have been referred to the Nieper clinic by promotional groups in Wisconsin and California, including the recently established Hans A. Nieper Foundation. FDA has advised these groups that they should correct any materials they send out that suggest drugs prescribed at the Nieper clinic can be legally shipped to the United States.

The American Cancer Society reports that the Nieper cancer therapies include the discredited amygdalin (laetrile) and such other unproved substances as Iscador, fresh cell therapy and wobe-mugos enzyme. The American Heart Association says the drugs reportedly used for his cardiovascular treatments include bromelain, carnitine, selenium, magnesium orotate and potassium orotate—for which “there are no significant data indicating that any of these drugs are efficacious.” The American College of Cardiology strongly warns against any use of unapproved drugs for treatment of cardiovascular disease, adding that lithe FDA review process has done much to protect the American people from exposure to unsafe and ineffective drugs.”

And the National Multiple Sclerosis Society advises that the calcium products, including calcium aminoethyl phosphate or CaEAP, frequently prescribed as part of an expensive program of massive drug intake and special diets “has not been demonstrated to be effective in controlled experiments. II The German Multiple Sclerosis Society, according to its counterpart here, strongly advises against the treatment methods of Dr. Nieper.

In a 1981 advisory, the National Multiple Sclerosis Society emphasized that “when a physician makes a claim of producing a clinical improvement in MS, that physician has a moral and professional responsibility to prove scientifically the specificity of the treatment.” Nieper had by then been making claims about multiple sclerosis for more than a decade and had not yet—and still has not—been willing or able to demonstrate the effectiveness of his therapies to other scientists.

(from Quackwatch)

This is, incidentally, why in the USA lithium orotate is marketed as a dietary supplement rather than a drug. Since 1994, the FDA has (by law) regulated dietary supplements as foods rather than drugs. Whereas a drug has (in theory at least) to be shown to be safe and effective in order to be legal, dietary supplements are banned only if they’re shown to be unsafe. Marketing lithium orotate as a dietary supplement is clearly nonsensical and mendacious, it’s the same drug in lithium orotate as in lithium carbonate, the only possible difference is in how the drug is metabolised in the body.

Other Evidence (such as it is)

Lithium orotate is not entirely without an evidence base, although it’s a staggeringly small one. Nieper’s original study was published in 1973. Then three studies on rats were carried out by various people until the end of the 70’s. The first showed no difference between lithium in its carbonate, orotate or chloride forms. A later study involving the same author found that lithium orotate caused kidney problems (although a very large dosage of lithium was used, so it’s unclear how significant this finding is). Between these two studies, a different group of scientists found different results, concluding that “These data suggest the possibility that lower doses of lithium orotate than lithium carbonate may achieve therapeutic brain lithium concentrations and relatively stable serum concentrations.”

Later on in the 80’s, a study involving 105 alcoholic patients (63 of whom dropped out before the six month study was completed) who were treated using lithium orotate and various Nieper-influenced mineral supplements concluded that “Lithium orotate therapy was safe and the adverse side effects noted were minor, i.e., eight patients developed muscle weakness, loss of appetite or mild apathy.”

Finally, last year a case report of a young woman who had overdosed on lithium orotate supplements (which bore the embarrasingly hideous name of “Find Serenity Now”) was published in the Journal of Medical Toxicology. She developed a mild tremor. The authors conclude that “Over-the-Internet dietary supplements may contain ingredients capable of causing toxicity in overdose. Chronic lithium toxicity from ingestion of this product is also of theoretical concern.”

This is not a lot of information to go on. There’s Nieper’s odd and scientifically dubious theories about orotates, a few studies which don’t shed much light on whether lithium orotate actually behaves very differently than lithium, a limited study on alcoholics that doesn’t really prove much either way and someone who overdoses and develops mild symptoms. Frankly, anyone deriving any certainty from this tiny slice of knowledge is crazy. Or trying to sell you something.

Selling Lithium

So, we already know why lithium orotate is sold as a dietary supplement (selling it as the drug it obviously is would incur the wrath of the FDA). But look at the marketing that some of these vendors use. For example, the horribly named Find Serenity Now:

Serenity™ is an all-natural, effective mood enhancer. It promotes a natural balance to moods and emotions. Serenity™ does not lower energy levels and has no known side effects. Serenity™ changes peoples’ lives for the better every single day.

…

A key step in producing Serenity™ is our advanced ‘Micro Vortex Enteric Coating’. This is a required process of Urban Nutrition’s authentic formula, ensuring that the stomach acids are by-passed so the Orotate can carry the natural Lithium and release it within the cells where it is utilized as a trace mineral in the body.

The combination of the Orotate mineral carrier and our Micro Vortex Enteric Coating manufacturing process make Serenity™ a natural & effective product. This provides optimal absorption and there is little or NO excess lithium left in the body. Research has demonstrated that this does NOT raise the lithium levels in the blood at all or in any significant way. Therefore, toxic levels of Lithium are not an associated problem with Serenity™.

You’ve seen the total extent of research into lithium orotate. Do you think these claims reflect the facts in any way? But that’s OK, because Serenity™ can help you if you have occasional mood swings, could use a boost in your spirits, your marriage suffers from unstable emotions, you’d like a natural mood enhancer, you long to find the person you deserve to be, or even if PMS or menopause feels like a curse.

No mention of actual medical disorders there, so that’s all right then. Still, I do have one question: Who the hell takes lithium in order to find the person they “deserve to be”?

Another lithium orotate supplement Symmetry Homeopathic Spray from HBC Protocols™ seems a little more bold in its claims to:

Oh, that bit about being FDC/NDC (National Drug Code) Registered? That’s a bit of regulatory fluff. The FDA maintains a database of drug products. It publishes a database of prescription drugs and insulin products (which Symmetry, being neither, doesn’t appear on). You submit your product’s data to the FDA and they give you a number. Implying that this is some kind of mark of approval is like me saying that the UK government approves of me because hey, I have a national insurance number.

No, I’m not sure what makes it a homeopathic spray either.

They also say:

If you cannot tolerate higher doses of lithium due to side effects you might try replacing it with lithium orotate. It requires no blood tests and side effects are pretty much non-existent. It is non-prescription and even at lower doses is just as effective as much higher doses of the prescription forms of lithium.

Strong claims, especially given the incredibly limited amount of evidence for lithium orotate. And isn’t it kind of irresponsible to recommend that people who are taking lithium (who will almost certainly have been prescribed it) should switch from an approved form of the drug to a form that was last studied with any seriousness in the 1970’s?

Come back FDA, all is forgiven

These aren’t the only places selling lithium orotate while implying that it’s a great replacement for your regular lithium. There’s hundreds of alternative medicine places online that seem to be at it. It seems stunningly irresponsible to me and I’m mildly surprised that the FDA haven’t been around with their big hammer of regulation. I don’t approve of everything the FDA do (then again, it’s not like I have to care - I’m English), but isn’t this precisely what the FDA is for?

They do appear to have stopped a shipment of Chinese-produced lithium orotate from entering the USA in January on the basis that it’s an unapproved drug, but these ‘dietary supplements’ are still available.

There appears to be at least one UK company that sells the drug, too.

Lithium is a powerful drug and even if you believe the unsupported assertion that the orotate salt is miraculously side-effect free, anyone taking it probably needs to do so under the supervision of someone who knows what they’re doing, what lithium toxicity looks like and is able to evaluate whether the stuff is working or not. This is true for lithium carbonate and I’d say it was even more important for this stuff to be in place when we’re talking about a mostly untested variant with such a small evidence base.

Last time I felt up enough to deal with life, I cleaned out the cupboard under the sink, confessing my past cleaning sins of hiding the dirty dishes there because I didn’t have enough energy to actually wash them up. So now that I’m back up again, I’m dealing with the wardrobe.

My wardrobe has become, over the last year or two, a respository for clothes I could never get around to washing. Back when I was working, I was constantly trying to get washing done in time for Monday. I clung to the idea that so long as I had five shirts and two pairs of trousers clean for the working week I’d be OK. I usually managed to bung in a couple of handfuls of socks and underwear, too. And if I was lucky, a couple of t-shirs for when I was at home. This turned out to be just enough to get by. Most of the time. I don’t have a clothes-dryer and hate going to the laundrette, so I have to hang my clothes up to dry.

Anyway, since I was always washing my clothes just in time (or sometimes not quite in time - my Monday shirt would sometimes be slightly damp around the edges and have to dry off on my forty minute walk) I never got around to the folding-and-putting-away stage of the whole clothes-cleaning process. Whenever I desperately had to clean up, I’d throw any dirty clothes into the wardrobe (I’d have put them under the sink, but it was full of dirty dishes) and pretend they weren’t there.

I’ve been living like this for a while. I’ve got slightly better at doing my laundry and usually have clean t-shirts and so on. My jeans were a bit of a problem until recently - I’d lost my other pair in the wardrobe that Persil forgot. So I only really had one pair. I always had to time the washing of them to coincide with a period of two or three days when I knew I wouldn’t have to go out. I’ve found them now, so it’s a lot easier. When I lose a bit of weight I’ll be able to fit into some more, I suspect.

I’ve been washing clothes over the last few days. In this summery weather it doesn’t take them long to dry. And I realised that I have nowhere to put them. For the first time in a long time I have a surplus of clothing that needs to be neatly folded and stored. So I’ve cleaned out my wardrobe, decided what to throw out and prioritised what needs to be washed firstl. I’ve even paired up my goddamn socks.

Therapy today went well. Then I came home, (accidentally) broke my computer’s keyboard and went out again to get a new one from Maplins. It’s nice to have a keyboard that doesn’t have a three-year old plague factory composed of crumbs and dead skin cells slowly evolving in its inner workings. This new one - the cheap wired model from Microsoft - also has a range of semi-useless buttons at the top. You mean I can launch the calculator simply by pressing a button on my keyboard?! Wow! My verdict so far: Not clicky enough, but decent enough for a tenner.

It’s the first keyboard I’ve ever had that has a detailed safety warning filled with paranoia about musculo-skeletal diseases. Seriously. There’s even a tag on the lead that says in black lettering on a bright red background: See bottom of keyboard for HEALTH WARNING!. It also instructs me not to remove the tag. Oh, Microsoft, with this crazy liability evasion you are really spoiling us!

I played with my guitar for a while and now the tips of my first three fingers are an interesting mix between numb and bruised. Still, I can now almost play the whole of the song A Whole New World from the Disney movie Aladdin. Yes. I know. Don’t think I’m proud of it, but it was the least complicated song I could find tabs for - all single notes played slowly, which is just about my level at the moment.

While I was getting my new keyboard, I also picked up some CFL’s (that’s compact fluorescent lamp, or energy-saving lightbulb as they’re otherwise known). I’ve been living with just the one rather ambient bulb for the last few months, because the only other lights in here are a strip of spotlights, which unfortunately seems to eat bulbs. The thing was going through them at a rate of at least one per month and once the first one had gone, the second and third would die soon afterwards. They’re screw-cap bulbs, too, which makes them less easily available and more expensive than your regular bulb. It was getting expensive. So, to wrap up this dull paragraph about light bulbs, I decided to get the CFLs in the hope that they’ll actually last for a while.

Anyway, I didn’t realise just how bloody bright they’d be. I’m glad I cleaned up in here, because seeing everything in their piercing ultra-cold light is bad enough without them illuminating dust, dirt and clutter.

My guitar arrived today in a huge box with an amp, a stand and various stuff. So I tuned it, and have just spent the last twenty minutes causing terrible pain in three of my finger-tips (damn you, A chord!) I spent a few hours yesterday cleaning my room up so I’d actually have somewhere to put the thing. I hadn’t really intended to go to that much effort, and even last week, I don’t think I’d have been able to get the required motivation together. I’m not sleeping properly at all, but I’m feeling pretty good.

This t-shirt I ordered a month ago also arrived today. I’m going to wear it to my therapy session tomorrow. Such irony! Such post-modern shits and giggles! Who could resist?

I think I’m going to wander down to the supermarket to get some food soon. Over the last few weeks my healthy diet has collapsed. Last time I ordered food I didn’t bother to make the salad that I normally do, which sees me through most of the week. The reason for this was that making the salad would have meant that I needed to wash-up the dishes in the sink and before I knew it the week was gone and the salad items were rotting in my fridge. (I managed to throw them out before they actually started to rot, but it was a near thing). And since then, I’ve been living from day to day, mostly on junk. Which obviously sucks. So I’m going to the supermarket to get actual food for now, and then I’ll probably order some food off the internet so I can start eating properly again.

I’ve just noticed that in a couple of weeks I’ll have been a non-smoker for half a year. I’m actually quite proud of myself. I still get the occasional jones on for a cigarette, but not very often and it always passes after I stop thinking about it. I feel a lot better about having just spent £150 on a guitar when I realise that I must have saved at least £800 simply by not sucking ash into my lungs.

I started thinking about buying a guitar on Friday. I was setting pay-pal up, which required me to check my bank account. Seeing that I had a reasonable amount of money in my account, I felt that I could afford to buy something interesting to occupy my attention. I had been considering buying a second hand playstation 2 off eBay, but I’m not really much of a gamer. Then I decided I wanted a guitar.

I used to own one. I got it when I was 12 or 13 so that I’d have something to talk about with a girl I liked, who also played guitar. This plan didn’t work. I don’t think I’d planned anything to say after “So, I’m getting a guitar.” Anyway, I got a guitar and my mum, thankful that I had finally developed some kind of interest outside of hiding in my room, paid for lessons. I wasn’t very good because I didn’t practice much.

The weird bit of this is that my mum decided to learn guitar, too. At least I think this is weird, but it’s hard to tell. Certainly, it’s difficult to be a dead cool guitar-playing rockstar when your mum’s better at playing the guitar than you because she practices. My mum had a habit of getting slightly too involved. A few years later, when I went to night school to get my A-Levels, my mum decided that she wanted to do an A-Level too. So we both did English Literature and I did English Language on my own.

This is kind of weird, isn’t it? To be honest, I think she was just glad to have an excuse to get away from my father for a while. Then again I don’t really understand what was going on in my mother’s head a lot of the time. For instance, there were a couple of times in my childhood when things I wanted to do were completely shot down for what now seem like particularly weak reasons.

Shit. My awesome guitar-purchasing post has turned into another uncomfortable analysis of my family’s strangeness and dysfunction. Let me reiterate: Awesome guitar-purchasing!

So anyway, I know the very basics of playing a guitar and can even manage a rather tortured version of Smoke on the Water. And I have a lot of free time at the moment. And I can afford it, even if spending money makes me feel guilty. It’s not like I just bought a Fender Stratocaster. No. What I’ve bought is a cheap, but well reviewed Yamaha. I don’t want a flashy guitar that I don’t know how to play; I want a cheap, but decent guitar that I can learn to play on. And that’s what I’m getting. In metallic red.

I’m not getting very much sleep at the moment. I may be going slightly crazy.

The weekend was good. Went to another city. Drank large amounts of beer. Caught up with old friends. Played on SingStar and didn’t make a complete twat of myself. And I did it all in a t-shirt. My arms and their scars were visible the whole time. And it was OK.

I went down the shops earlier to get a bit of food. And I decided that I’d leave my jacket off. It’s one thing doing it when I’m surrounded by my friends, but another thing to do it on my own. And it was weird, but I did it. Admittedly I shut out as much of the world as I could, with my mp3 player on loud and I wore the sunglasses that I bought on Friday, which also seem to make things easier. I felt a bit exposed, but nobody seemed to take much notice. And it was nice to not be way too hot.

So, fuck it, I’m not ashamed of my scars and I’m done being worried about what people will think if they see them.

My sleep patterns are astoundingly screwed-up at the moment. And they were pretty screwed-up to start with. I’ve been awake long enough for me to take my daily medication twice. So far. And I can’t get to sleep. Don’t think I haven’t tried.

And now, some students who live in the houses to the back of this block of flats are having another party. They (or possibily other students who live on that street) keep on doing this. Ironically, I have to get up earlyish tomorrow so I can go to my friend’s birthday thing, although this will be mostly spent in a number of pubs. And not in a built-up residential area.

On top of this, a small group of people who live in these flats have taken to getting in at 3AM, then running up and down the corridors shrieking for no apparrent reason. Yesterday someone put a sign up offering them physical violence if this continued. Last night it happened again. Today the sign was torn up on the floor. As far as I know, no physical violence was delievered.

Being drunk is not an excuse for being an inconsiderate fuckwit. Not that I was asleep, but still.

God, I hate people.

I took my first tiny little dose of lamotrigine today and so far I haven’t developed any fatal rashes. Yay me!

Not that this matters to anyone else, but I’ve been having trouble with my feed reading software for the last week and have now switched from Thunderbird to the recently-turned-into-freeware NewsGator FeedDemon, which seems pretty good so far.

I stumbled upon the Almost-Dead Poets Society blog yesterday. I don’t do poetry myself. Usually. But I was kind of inspired to pen this bit of doggerel, which amused me:

Everything burns eventually
and that’s not such a great calamity.
All I lack is quality,
no wealth, no fame, no infamy
and no sense of any possibility.

I can’t decide if it’s not to be
or to be’s the solution meant for me.
These days I sleep fitfully
and they’ve all got in in for me.
Should I reduce myself to anatomy?

Ugh. Yesterday sucked. After a night of really weird dreams, I woke up dizzy and spent the day alternating between shivering and burning up. My head felt like someone was hammering nails into it. Thinking hurt. Everything ached. I took some ibruprofen which seemed to have no effect whatsoever. My usual visual stuff (visual snow, etc.) was much worse than normal. I kept my curtains drawn all day because the sunny day outside was unbearably bright. I felt a lot better by the evening, and today I feel fine.

So anyone care to guess: Weird migraine or just a short-lived virus? I get these things occasionally.

Today I went to see my GP, who prescribed me lamotrigine (AKA Lamictal). He obviously hadn’t read my psychiatrist’s letter to him about this until the appointment. I think I may have appeared a little smug as I quoted the BNF prescribing guidelines at him. But I now have my first month of tiny little pills, which I’ll probably start tomorrow morning.

Actually, I’m going to a birthday thing at the weekend, which will probably involve lots of alcohol. I’ve had a look around the ‘net and there’s no official advice to avoid alcohol, although some sites seem to suggest that mixing lamotrigine and alcohol leads to sedation. Has anyone who’s actually taken the stuff experienced this?

They say that suicide is a permanent solution to a temporary problem. And this is true. But it’s suicide’s permanence that attracts me and my problems may well only be temporary in the sense that they’ll definitely be over after I die, whether that’s now or in fifty years. Being an atheist I don’t have to worry about what happens next: I’m certain that nothing does.

I think about suicide a lot, mostly in the background. It’s comforting in a way, knowing that I have an exit. It’s good to know that I’m prepared, that I have my plan and the necessary resources to carry it out. And paradoxical though it may sound, this is why I haven’t actually tried to kill myself in the last decade. Making suicide attempts is probably easier when there’s some element of doubt. I’ve felt like this for years. I started thinking about suicide when I was 11 or 12. It doesn’t disturb me much usually. You get used to it.

These last few days have been more wearing. These thoughts of suicide haven’t been the safe kind. They’ve been intrusive and a bit distressing. This happens sometimes and I usually deal with them by making a decision to wait and see, to make sure I’ve explored other options first. But it’s getting more and more difficult to believe that any other option will make the slightest difference.

Which isn’t to say that I’m going to do anything about these thoughts - they’re uncomfortable, but I don’t feel particularly unsafe. It’s just that everything around me is utterly bleak. At the moment I’m absolutely certain that suicide is eventually going to become a necessity. Not right now, but not that far away. I’ve fucked my life up and continuing to live this pathetic sham is just too hard. I’m probably not able to accurately estimate this stuff at the moment, but it’s how I feel.

The other day a friend from university was in town so we went out for a couple of drinks and shared a pizza. It was really nice seeing her and I managed to seem relatively OK. It was good. But in many ways the good days are harder than the bad. Because they’re really not that good and they make me wonder if this is the best I can hope for. Because if it is, I don’t want to be here.