Jul 23, 2026 · 1 hr 12 min · 13 segments
Bipolar disorder treatment is put to the test in this clinically grounded tier list with psychiatrist Jim Phelps. He and Dr. Malzberg rank low-dose lithium, lamotrigine, social rhythm therapy, dark…
Jim PhelpsGuestMalzbergHostSo today, I'm doing something a little clickbaity with you.
We're doing the tier lists, and I want to do bipolar treatments.
And I gave Dr. Phelps a little rundown on how tier lists work, but we might be figuring it out together.
So I put together...
There's a few things I've learned from your videos that aren't in your standard conventional psychiatric treatments, and then some things that are standard treatments that I think you just have brilliant commentary on it.
So what we'll do is I'll give you one of those treatments, and then I want you to rank it from S being the A-plus to A, B, C, or F.
And then talk to me a little bit about just why you put that ranking, how you think about it and how you use it.
And then I'll just ask some random questions.
If you have any questions along the way, feel free to ask me.
So we're going to start out with low dose lithium.
And you put it in that upper left-hand corner on purpose because we had talked about what things are likely to change people's clinical practice.
I don't know how much you want me to go on on each one of these, but that would be the short version.
No, I want you to go on as long as possible.
I'll interrupt you.
So talk to me about where you see it work, how you think about it, how you use it.
What is it? What do I use it for? Why do I think it's so important? What is it? Starting with 150 milligrams because that's the smallest dose we can engineer and going up by 150 milligram steps every four to seven days and nights until something good happens, something bad happens, go back down one step or you get to 600 milligrams daily and then check a level.
So it's starting low and going up fast or slow depending on how anxious the circumstances are.
And with a target of a relatively low dose, 600 or so, before you arrive at any other evaluations of its efficacy or its potential risks.
The probability of doing renal damage with this is extremely low unless you're not watching out for non-steroidals and antihypertensives.
So today, I'm doing something a little clickbaity with you.
We're doing the tier lists, and I want to do bipolar treatments.
And I gave Dr. Phelps a little rundown on how tier lists work, but we might be figuring it out together.
So I put together...
There's a few things I've learned from your videos that aren't in your standard conventional psychiatric treatments, and then some things that are standard treatments that I think you just have brilliant commentary on it.
So what we'll do is I'll give you one of those treatments, and then I want you to rank it from S being the A-plus to A, B, C, or F.
And then talk to me a little bit about just why you put that ranking, how you think about it and how you use it.
And then I'll just ask some random questions.
If you have any questions along the way, feel free to ask me.
So we're going to start out with low dose lithium.
And you put it in that upper left-hand corner on purpose because we had talked about what things are likely to change people's clinical practice.
I don't know how much you want me to go on on each one of these, but that would be the short version.
No, I want you to go on as long as possible.
I'll interrupt you.
So talk to me about where you see it work, how you think about it, how you use it.
What is it? What do I use it for? Why do I think it's so important? What is it? Starting with 150 milligrams because that's the smallest dose we can engineer and going up by 150 milligram steps every four to seven days and nights until something good happens, something bad happens, go back down one step or you get to 600 milligrams daily and then check a level.
So it's starting low and going up fast or slow depending on how anxious the circumstances are.
And with a target of a relatively low dose, 600 or so, before you arrive at any other evaluations of its efficacy or its potential risks.
The probability of doing renal damage with this is extremely low unless you're not watching out for non-steroidals and antihypertensives.
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