Personal blog of Dr Alex Mendelsohn

Month: July 2023

Previous article clarifications

The blog post discusses Alex’s experience as a psychiatric patient and their past experience as a physics researcher. They express concern about readers misinterpreting their writing as advice and clarify that they are not in a position to make recommendations. The post revisits and clarifies statements made in previous articles about the psychiatric system, particularly a Physics World article and a Lithium Story article.

In the Physics World article, Alex discusses their frustrations with the psychiatric system compared to the scientific rigour in physics. They acknowledge that their emotional state at the time influenced their writing, leading to oversimplification of complex issues. Alex clarifies certain statements made in the article, specifically regarding psychotropic drugs treating symptoms and the difficulty in diagnosing patients based solely on symptoms.

In the Lithium Story article, Alex discusses their experience with taking lithium as part of their treatment. They clarify certain points, including the dosing regimen they found most effective, their decision to trial lithium over other medications, and their concerns about potential renal effects. Alex also emphasizes that they are no longer taking lithium but found it helpful during their treatment journey.

Throughout the blog post, Alex emphasizes the importance of clear and precise language, drawing a comparison between the clarity in physics literature and the ambiguities they encountered in some psychiatric research papers.

Alex invites feedback and criticism, acknowledging their limited knowledge of psychiatry and their ongoing recovery as a mental health patient. They encourage constructive input with proper citations and references to support claims.

One of my worries when writing articles about the psychiatric system is that a reader will interpret arguments I make as a form of advice. I want to make clear I am not in the position to make any recommendations. I write from my current experience as a patient and past experience as a physics researcher to hopefully add a few insights where psychiatric research, lived experience and physics meet.

So, when someone seemingly mis-read and mis-interpreted my Lithium Story article, I was a little distressed. I re-read the opening paragraph of my article. While I was telling a story of my opinions at the time, I could see how it might have been possible to interpret it as a recommendation for twice daily dosing. This was not my intention. I am not against once daily dosing.

I realised this was an opportunity to look back and clarify past statements I have made in both my Physics World and Lancet Psychiatry articles.

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How I found Amdisen’s original research papers

Alex describes his experience of taking lithium and his search for information on its pharmacokinetic properties. He wanted to calculate his peak serum concentration and find out his approximate lithium half-life using the exponential decay formula. However, he found that there was no semi-log plot in the literature and no mention of the dual half-life of lithium. He searched for papers on simulations of the pharmacokinetic curve and found references to multi-compartmental models. Eventually, he found a chapter on lithium pharmacokinetics in a book and learned that the two half-lives he observed corresponded to the alpha and beta phases of lithium removal from blood vessels after peak concentration, which could be described using multicompartment models.

When I first started to take lithium, I wanted to calculate my peak serum concentration using my 12-hour sample value. I knew it was going to be a very rough estimation, but for me, doing the calculation made me feel less anxious about toxicity.

My plan was to use the exponential decay formula 1 to find the peak concentration (assuming the peak occurred around five hours). I wanted to find out, given I knew my serum creatinine levels, what my approximate lithium half-life was. I went looking for data in the lithium pharmacokinetic literature to figure this out.

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