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Orthomolecular psychiatry is a branch of orthomolecular medicine whose proponents claim that dietary supplements and other treatments can be effective in treating mental illness. The approach uses individualized testing and diagnosis to establish an etiology for each patient's specific symptoms, and tailors the treatment accordingly using a combination of nutrients, dietary changes and medications to enhance quality of life and reduce symptoms.

The origins of orthomolecular psychiatry date to the 1920s, and the work of Abram Hoffer in the 1950s established the orthodoxy of the field. In 1973, a task force of the American Psychiatric Association examined and rejected the practice and it has been considered an alternative therapy since that time. The methods and conclusions of used by the APA to reject orthomolecular psychiatry have been challenged, rejected and strongly criticized by proponents of orthomolecular psychiatry for being politically motivated and scientifically unfounded. Current scientific research supports some of the theories advanced by orthomolecular psychiatrists.

History

The origins of orthomolecular psychiatry can be traced to as early as 1927. Orthomolecular psychiatry per se is, however, generally accepted to have begun in the 1950s with the work of Abram Hoffer and Humphry Osmond in Canada. Later proponents include Carl Pfeiffer, David Horrobin and Linus Pauling.

The earliest assertions by proponents of orthomolecular psychiatry were rejected in 1973 by a panel of the American Psychiatric Association, which instead used its own broader defined, different methodologies which included many patients who were subsequently recognized in conventional psychiatry to have had different psychiatric conditions. Orthomolecular psychiatry subsequently found scant support in mainstream psychiatry and is currently considered an invalid form of treatment.

Diagnosis

Proponents of orthomolecular psychiatry claim to have identified the causes of some psychiatric syndromes, in particular of those that cause psychosis; testing for these causes guides diagnosis and treatment. Diagnostic measures and therapies commonly employed include individual biochemical workup, fasting, identifying allergies, dietary changes, megavitamin therapy, aminoacids, and other pharmacologic nutrients.

Treatment

Treatment generally involves the administration of the 'right' substances (ortho meaning right in Greek); generally this involves administration of high doses of vitamins, essential fatty acids and other substances already produced or required by the body. Orthomolecular psychiatrists do not categorically refuse to prescribe psychotropic medications; antipsychotics are often used to stabilize a patient, and anti-epileptics, dilantin in particular, are occasionally used to treat histadelia. Not infrequently, the improvements orthomolecular psychiatrists can adduce are sufficient to allow patients to reduce, but not eliminate, their reliance on conventional psychotropics.

Orthomolecular methods have been claimed as effective in treating Alzheimer's disease, dementia, tardive dyskinesia, bipolar disorder, schizophrenia, ADHD and some of its sub-types.

Specific conditions

Schizophrenia

According to orthomolecular psychiatry, the causes of psychotic disorders include pyroluria, histadelia (elevated histamine and basophiles), histapenia with high serum copper (low histamine with high copper), food allergy, hypoglycemia, hypothyroidism in the presence of normal thyroid values, heavy metal intoxications, as well as other rarer conditions.

Hoffer and Osmond developed and used the "Hoffer-Osmond Diagnostic test" of perception, their biochemical research as available in the 1950s and 1960s, and length of illness, acute vs. chronic, to identify, differentiate and monitor schizophrenic patients' progress, with more specific classifications in schizophrenia for orthomolecular treatment than the then accepted, broader classifications of the schizophrenizas. Many orthomolecular physicians still prescribe an initial course of antipsychotics for schizophrenic patients with the long-term goal returning patients to health, and avoiding antipsychotics due to their side-effects. Orthomolecular psychiatry's goal of weaning patients from conventional neuroleptic drugs follows 'Pfeiffer's Law', "For every drug that benefits a patient, there is a natural substance that can achieve the same effect".

Megavitamin and dietary therapy to treat schizophrenia was tested in 1999 and found to be effective at increasing serum levels of vitamins, but did not show any impact on symptoms of schizophrenia.

Bipolar disorder

Omega 3 fatty acids have been demonstrated to assist in treating bipolar disorder, in keeping with orthomolecular psychiatry's assertion that foods can be used to treat mental illness. Omega fatty acids also show promise or use in treating many other conditions.

Depression

The orthomolecular treatment of depression generally consists of treating histadelia, which can cause depression without psychosis, with methionine, or augmenting other aminoacid imbalances.

Methionine and coenzyme S-adenosyl methionine have been found to be effective in treating some forms of depression, as Pfeiffer and others report. One paper in the Lancet reported that methionine in the form of S-adenosylmethionine was as effective as conventional antidepressants, and linked depression to a disorder of methylation, one of Pfeiffer's theses.

The amino acid tryptophan, a precursor of serotonin, is also used to treat some forms of depression; very significant differences were found between plasma tryptophan levels in patients suffering from depression and healthy controls. There are reports that tryptophan is effective in the treatment of mania. Mainstream psychiatry often treats depression with selective serotonin reuptake inhibitors.

Treatment centers

Currently, orthomoleculary psychiatry continues to be investigated by a small number of researchers. The Pfeiffer Treatment Center is dedicated to the research and use of orthomolecular psychiatry in the treatment of schizophrenia, bipolar disorder, autism, and violent criminal behavior.

Relationship to mainstream psychiatry

Orthomolecular psychiatry is has been rejected by the mainstream medical community, as has the use of dietary interventions to treat psychological health. Critics have noted that the claims advanced by its proponents are considered unsubstantiated, and even false, by conventional psychiatry. Authoritative bodies such as the National Institute of Mental Health and American Academy of Pediatrics have criticized orthomolecular treatments as ineffective and potentially toxic.

A 1973 task force of the American Psychiatric Association charged with investigating orthomolecular claims, but instead focused on niacin monotherapeutically (the earliest version of treatment, ca. 1952) for a different kind of patient population, unanimously concluded:

This review and critique has carefully examined the literature produced by megavitamin proponents and by those who have attempted to replicate their basic and clinical work. It concludes in this regard that the credibility of the megavitamin proponents is low. Their credibility is further diminished by a consistent refusal over the past decade to perform controlled experiments and to report their new results in a scientifically acceptable fashion. Under these circumstances this Task Force considers the massive publicity which they promulgate via radio, the lay press and popular books, using catch phrases which are really misnomers like "megavitamin therapy" and "orthomolecular treatment," to be deplorable.

A study of the effectiveness of an orthomolecular treatment for acute schizophrenia began in 2005, attempting to adequately address the failings of previous APA studies to use an appropriate treatment group and intervention.

Controlled studies using the orthomolecular approach have been few. Those that were done were performed in chronic schizophrenia or in populations that included bipolar and schizoaffective patients. Both of these diagnostic groups are not today considered to benefit from the orthomolecular approach. Moreover, some negative studies of high-dose niacin were done in patients who were not otherwise given general counseling for good diet."; compared with a basic, modern orthomolecular regimen.

Proponents consider the 1973 APA task force report error laden with sweeping, scientifically unfounded conclusions, highly politicized, and that its studies failed to use similar methods, materials and subjects as the original work. The APA report's criticism alleges inadequate controlled trials because Hoffer quit running additional blinded tests that he had come to view as unethical for his patients, especially since the results of his previous double blinded tests went unheeded. The APA's assertion is made despite Hoffer's claim to have run the first double blind controlled test in psychiatry, on megavitamin therapies, with a total four double blinded tests, up to 19 years before the APA task force report, as well as being supported by two independent double blinded tests and an extensive biochemical research program. One of the APA report's five authors, psychologist JR Wittenborn, reacting to Hoffer's specific criticisms, later re-analyzed his original double blind study favorably with respect to orthomolecular psychiatry, obtaining the same result as Hoffer, and never received NIMH or APA support again. According to Hoffer, APA task force co-author Thomas Ban was well known for his tranquilizer studies and that Ban previously stated that much of his income derived from grants from companies and other sources interested in selling tranquilizers. APA task force co-author, then NIMH member Loren Mosher, prior to the serving on the panel, had stated forcibly that if every psychiatrist in the USA believed that megavitamin therapy helped schizophrenic patients, he would not believe it. Mosher later resigned from the American Psychiatric Association in total disgust for reasons unrelated to orthomolecular psychiatry, and referred to the organization as a "drug company patsy."

Current research

Food allergies

A 2006 literature review noted that studies had found that the frequency of schizophrenia in patients with celiac disease to be significantly above average; one study found schizophrenia to occur in patients with celiac disease 3.2 times as often as in the general population. The review reported that some studies suggest that removal of gluten from the diet of a subset of schizophrenic patients may reduce symptoms in a subset of patients, but that others have seen no effect from dietary changes. It noted that the sample sizes in the studies that found no improvement were very small, so that if only a relatively small subset of schizophrenics do improve, the odds of these studies, one of which was otherwise flawed, not including any of these less common cases was between 48% and 75%. The review attributed the hesitancy with which these positive results have been been received to the fact that many of them had been reported by a group lead by the same researcher, FC Dohan. Dohan reported in one study of 102 patients that 62% of the patients in a locked ward could be discharged to an unlocked ward within 7 days compared to only 36% on a high cereal diet. Another study found that after 90 days, 37.2% of the patients on a gluten and milk-free diet had been discharged from the locked ward compared to 16.1% on a diet rich in cereals. Neither study was double blind, however secretly adding gluten unbeknownst to patients or staff was found to negate the observed different rate of recovery. Other studies not conducted by Dohan have reported similar findings, or symptom improvement on a gluten-free diet which dramatically worsened when gluten was reintroduced.

Also mentioned was a 1997 article about a woman with schizophrenia and celiac disease who experienced a remission of both illnesses when gluten was removed from her diet. SPECT scans before and after the adoption of a gluten-free diet change showed a remarkable resolution of the decreased blood flow to the brain's cortex, which is associated with schizophrenia. The review concluded that large randomized clinical trials will be required to verify if there is a genuine causal relationship between diet and schizophrenia. Removing gluten and other allergens had long been recommended by orthomolecular psychiatrists when indicated.

Copper

The only neurological disease that has been unambiguously proved to be caused by an accumulation of copper to toxic levels is the genetic disorder called Wilson's disease. Carl Pfeiffer proposed that a form of schizophrenia or dementia he named histapenia involved the accumulation of toxic levels of copper without the liver damage copper toxicity causes in Wilson's disease; his beliefs were dismissed by the mainstream medical community. More recently there has been considerable mainstream scientific interest in the hypothesis that Alzheimer's disease may instead involve reductions in the levels of copper in the brain. These results have led to initial clinical trials of copper supplements as a possible treatment for Alzheimer's disease. The use of the copper chelator clioquinol has also been proposed. This compound showed promise in initial studies, but a recent meta-analysis stated that firm conclusions cannot be made from these small-scale trials. However, if this effect is genuine, the mechanism of action of this drug is unclear, with some suggesting that clioquinol may be an ionophore that transports copper into the brain.

A scientist specifically pursuing research in orthomolecular psychiatry has found that women who suffer from postpartum depression on average have a strongly significant higher level of plasma copper than women who haven't suffered from postpartum depression, and that males with a history of violence and assault have a significantly higher median blood copper / zinc ratio.

Histadelia

Carl Pfeiffer posited the existence of histadelia, a syndrome marked by high concentrations of histamine in the blood and "undermethylation", which he thought might cause depression and psychosis. Pfeiffer gave the amino acid methionine to people that he diagnosed with this syndrome. Although there is no published scientific evidence that methionine is effective in the treatment of these mental illnesses, research has shown that the coenzyme S-adenosyl methionine is an effective effective in the treatment of depression.

Amalgam intoxication

The Journal of Orthomolecular Medicine has published articles demonstrating correlations between amalgam fillings and schizophrenia, bipolar disorder, and multiple sclerosis. Perhaps coincidentally, in 1998 a dentist published on a patient of his, who had been diagnosed with multiple sclerosis by lumbar puncture whose symptoms resolved after her amalgam fillings were replaced. The patient's neurologist subsequently concluded that she had never suffered from multiple sclerosis. Another dentist has written a book describing what he claims are recoveries from multiple sclerosis after the removal of amalgam fillings. A paper on the effects of amalgam fillings on the immune system reported that they can cause basophil granulocyte levels to become extremely elevated, an anomaly by which histadelia can be diagnosed. These ideas are not accepted in mainstream science, and a recent meta-analysis of four epidemiological studies found significant statistical heterogeneity between the studies, but no significant association between amalgam fillings and multiple sclerosis.

Aging

The orthomolecular approach may be effective in the treatment of age-related brain deterioration.

Notable patients

Abram Hoffer reports that actress Margot Kidder credits orthomolecular psychiatry with helping her overcome bipolar disorder. Mark Vonnegut attributed his recovery from schizophrenia to orthomolecular psychiatry and advocated its adoption by mainstream medicine, but later disavowed his statements.

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Bibliography

  • Braverman, Eric R. (2003). The Healing Nutrients Within: Facts, Findings, and New Research on Amino Acids. Basic Health Publications. ISBN 1-59120-037-7.
  • Pauling PhD, Linus (1973). Orthomolecular Psychiatry: Treatment of Schizophrenia. San Francisco: Freeman. p. 697. {{cite book}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)
  • Pfeiffer, Carl J. Nutrition and Mental Illness: An Orthomolecular Approach to Balancing Body Chemistry. Healing Art Press. ISBN 0-89281-226-5.
  • Werbach, Melvyn R. (1999). Nutritional influences on mental illness: a sourcebook of clinical research. Tarzana, Calif: Third Line Press. ISBN 0-9618550-8-8.

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