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Guardian’s reporting on side effects of drugs for bipolar disorder hits many key points


4 Star


Lithium should be more widely used for bipolar disorder, researchers say

Our Review Summary

PrescriptionsThis story is about a study on the frequency of different side effects of four drugs used in the treatment of bipolar disorders. The researchers conclude that lithium should be used more widely, given its lower rate of side effects.

The story notes that lithium is documented by other studies to lower the risk of suicide, something that few treatments do in people with bipolar disorders–and a significant advantage given the substantial suicide risk in this group. It also notes that some of the drug’s bad reputation likely stemmed from the higher doses used in decades past and subsequent more side effects.

All in all, the story hit many of the important points in explaining the findings, though we wanted to see some discussion on the limitations of this kind of research, as well as costs of the drugs.


Why This Matters

Bipolar disorder, previously known as manic depressive disorder, is relatively common with a lifetime prevalence of about 3% in general population. Understanding the side effect profile of the drugs used to treat this disease, along with their relative effectiveness in reducing the burden of disease, are both essential in identifying the best treatment options for people. Unfortunately, comparative effectiveness studies are uncommon, but those that have been done have shown that the newer drugs are not better than lithium in terms of effectiveness. This study adds the important finding that lithium’s side effects are also not as burdensome as thought. It’s vital that this new information is conveyed accurately to the public.


Does the story adequately discuss the costs of the intervention?

Not Satisfactory

The story did not address costs. Because this ran in the U.S. edition of The Guardian, this is important and useful information for readers stateside, who often have substantial out-of-pocket drug costs.

Does the story adequately quantify the benefits of the treatment/test/product/procedure?


The research examined the side effect profiles of  lithium, valproate, olanzapine, and quetiapine and provided hazard ratios for the most commonly recognized side effects.

The Guardian story reflects those findings in a qualitative way with some quantitative details, such as: “Meanwhile, lithium patients were less likely to put on weight than patients on the other drugs. While 15%-20% of those on the three other drugs were more likely to gain more than 15% of their body weight, just 10% of those on lithium put on the same amount of extra pounds.”

Does the story adequately explain/quantify the harms of the intervention?


The story does a reasonable job in outlining the side effects seen with the four drugs in question and provides them in context.

Does the story seem to grasp the quality of the evidence?

Not Satisfactory

The reader is told: “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 disease, thyroid disease, weight gain and high blood pressure.”

These are important details, but we also wanted to see some nod to the caveats of the study, which were noted by the researchers in their paper in the “strengths and limitations” section.

Does the story commit disease-mongering?


There is no evidence of disease mongering. Given the seriousness of the disorder and its prevalence, we would have liked to have seen read more on how many people it affects.

Does the story use independent sources and identify conflicts of interest?


Although the majority of the quotes come from a senior author of the research, the comments of Stephen Buckley, head of information at the charity Mind were welcomed and provided an important second voice.  A few words from other clinicians would have been a bonus.

Does the story compare the new approach with existing alternatives?


The research examined the side effect profiles of the most commonly used drugs to treat bipolar disorder, it also discusses “talk therapy” (but not until the end of the story).

Does the story establish the availability of the treatment/test/product/procedure?


The story makes it clear that the four drugs studied are indeed available.

Does the story establish the true novelty of the approach?


The story begins with: The new study is the first to compare the side-effects of the four main mood-stabilising drugs prescribed by the NHS.”  Based on our review of the medical literature, we agree.

Does the story appear to rely solely or largely on a news release?


The story does not appear to rely on a news release.

Total Score: 8 of 10 Satisfactory


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