Mental health index

Allergies & environmental exposures

Allergies and environmental chemicals have a definite effect on mood and mental balance. Several psychiatric medications are in fact antihistamines. Environmental exposures to household cleaners, perfumes or carpets may produce symptoms similar to a panic disorder. In addition to environmental chemicals, heavy metals such as arsenic, lead, and mercury may also interfere with the chemistry of the mind & body. Children with high lead levels can exhibit lower IQ scores, learning disabilities, hyperactivity, aggressive or disruptive behavior, and difficulty maintaining attention. Mercury has been linked to Alzheimer's disease and other neurological problems. Last year a coalition of public interest groups sued the American Dental Association, claiming they have misled the public about the dangers of mercury in tooth fillings. Overall, it is important to identify, eliminate, and desensitize people to any harmful agents to the body & mind.
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Blood sugar

Changes in blood sugar levels may strongly influence changes in mood. Either high or low levels can easily create changes in hormones & neurotransmitters, which in turn creates changes in both mental & physical symptoms. For example, patients who suffer from diabetes have higher tendencies for depression. Low blood sugar (also known as Hypoglycemia) can easily create symptoms of mania, anxiety, depression, insomnia, irritability, and fatigue. All patients should be properly assessed for blood sugar disturbances.
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Diet—you are what you eat

Did you know that the brain is composed of 60% fat & 65% water? I do not mean fat from hamburgers but fat from fish, nuts, seeds, and vegetables. A study in Finland correlated depression symptoms with how often fish was eaten. Last year, a landmark study in a popular psychiatry journal showed that people with bipolar disorder given fish oils did better than those who did not. It is important to eat proper foods that ensure proper nourishment for the mind & body. Good quality fats and proteins from whole foods, fish, vegetables, nuts & seeds are ideal. Try to avoid or minimize refined foods & grains because they are generally have less fat, protein, fiber, and less vitamin & mineral contents. The more organic food the better.
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Exercise

Physical activity of some kind has profound antidepressant properties and provides great stability to both the body & mind. In a study group of elderly patients diagnosed with major depression, 60% no longer met the criteria for depression after 16 weeks of performing a brisk 30-minute walk or jog three times a week.
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Expression & creativity

I am often amazed at the intellectual & creative abilities of my patients with apparent mental disturbances. It is vital for all people to have creative outlets to express their gifts. Techniques such as Emotional Freedom Technique (EFT) & EMDR maybe helpful. EFT is an emotional or psychological form of acupuncture which utilizes meridian points to help heal negative or blocked experiences. Eye Movement Desensitization & Reprocessing (EMDR) is an innovative approach of psychotherapy designed to both alleviate & reprogram traumas.
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Gut

The highest concentrations of neurotransmitters in the body are found in the gut and not the brain. Over 60% of brain-type chemicals can be found there. In the gut, the natural chemical cholecystokinin is involved with digestion but in the brain it may relate to anxiety. Schizophrenia & epilepsy symptoms have disappeared in selected case reports when the food chemical gluten (found in most grains) has been removed from the diet. Hospitalized schizophrenic patients maintained on a cereal grain & milk free diet may improve about twice as faster than those who don't. When wheat gluten is secretly added back to the cereal grain & milk free diet, schizophrenic symptoms worsen. Psychiatrists generally do not screen for this problem. The bottom line to remember is that there are foods, food dyes, additives, other chemicals, which can be troublesome for your gut & your mood.
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Hormones

New evidence suggests that antidepressant medications may actually correct underlying hormone imbalances. Low levels of thyroid hormone, testosterone, DHEA or imbalances of estrogen & progesterone can severely disrupt mental functioning. All patients should be appropriately screened by saliva & blood hormone testing, and by physical signs & symptoms. For example, low thyroid function can be easily screened by performing a daily underarm temperature reading according to Dr. Broda Barnes, author of "Hypothyroidism: The Unsuspected Illness".
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Infections

Chronic infections can disrupt mental health, including infections in the teeth & jaw. Dr William Crook, the author of "The Yeast Connection" has popularized the role of yeast in health & disease. Autistic children may show signs of clinical improvement when appropriately tested and treated for yeast infections. It is interesting to mention that recent evidence suggests antidepressant medications (SSRIs) to be effective anti-fungal agents. Group A streptococcus (responsible for sore throats) may not only cause OCD & Tourettes, but also worsen anorexia, and perhaps others. A recent infectious agent, the Borna virus, has been strongly linked to chronic fatigue syndrome, depression, and schizophrenia. As you can see, having a healthy immune system is vital for good mental health.
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Medications

I remember treating a patient with insomnia by simply switching the timing of her thyroid medication. The patient was inappropriately taking the medication at night in stead of in the morning, which interfered with her sleep. Consequently, the patient no longer needed tranquilizers to help her sleep. Just remember that improperly prescribed medications can lead to both minor & major mental imbalances. Make sure you consult a competent healthcare provider or pharmacist. In addition it is important to be aware of medications that can interfere with nutrients & their absorption. For example, aspirin may interfere with Vitamin C and birth control pills may interfere with vitamins B6 & folic acid.
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Nutrition

Low levels of vitamins B3, B6, B12, and folic acid have been linked to depression, dementia, mania, and schizophrenia. Low iron can easily produce symptoms of depression or can enhance jitteriness in patients taking older antidepressants. An imbalance or deficiency of any one nutrient can produce mental symptoms. Consequently, a good multi-vitamin & mineral supplement plus B vitamins in the right doses can have a profound effect on mood. For example, the vitamin folic acid has been shown to enhance antidepressants (and reduce their side effects) and act as an antidepressant all by itself in the right dose. The pioneering psychiatrist Abram Hoffer has demonstrated tremendous benefit for schizophrenia and other mental illnesses with megavitamin and diet therapy. I have also found that the intravenous use of specific nutrients to be quite helpful in acutely ill patients. In fact, I have had several patients, who have not slept for several days, fall a sleep on the chair immediately after receiving intravenous nutritional treatment.
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Rhythms

Shift workers may have higher tendencies for depression. Airline crew attendants & passengers experience "jetlag" when the body's rhythms are disturbed. For several thousands of years people have been naturally programmed to sleep with the moon (or darkness) and rise with the sun. Only recently, during the last 100 years, has humanity challenged this delicate balance between the natural order of the environment and the body. Remember that the body functions in daily, weekly, and monthly cycles. For example, on a daily clock-work schedule the hormones testosterone, growth hormone, and cortisol spike or surge during the early mornings. Women experience monthly menstrual cycles. Consequently, disruption in these natural rhythms may create negative effects in the body & mind. Seasonal Affective Disorder (or SAD), for example, may be considered a form of disturbed natural rhythm brought on by reduced sun-light exposure during the fall-winter months. Overall, it is important to minimize factors which lead to imbalances in the bodies natural biological rhythms.
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Summary

It is important be well informed when considering treatment for mental disturbances. It is equally important to be properly screened for both conventional & unconventional causes. Proper diet & nutrition, exercise, sun light, and rest are great starting points. Identify food & environmental allergies. Pay close attention to medications, nutritional deficiencies, infections, and underlying diseases. Respect the body's natural rhythms, and the minds creative abilities.
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Mental healthcare—under the microscope

Over the past 10 years there have been alarming increases in diagnosis, prescriptions and spending in the area of mental healthcare. In fact, a front page article in the January 9th issue of the Washington Post revealed treatment for depression in the US has more than tripled during the last 10 years. Prescriptions for antidepressant medications (known as SSRIs) in young children increased from 1300 claims in 1992 to more than 25,000 claims in 1998 according to one study. Stimulant prescriptions increased from 24,000 claims to 135,000 claims. The economic costs to society and the personal & emotional costs to people and families are enormous.

Evidence suggests that treatment options for people suffering from some sort of mental disturbance needs to be questioned. For example, the American Journal of Psychiatry in 1994 published a surprising study that revealed no significant changes in clinical outcome for schizophrenia during the last 100 years! Prescription medications are generally the first line option given to most patients who suffer from a mental illness.

Ironically, because of negative side effects or poor treatment outcomes a high number of patients eventually refuse treatment. In a survey of 1000 patients conducted by the National Depressive & Manic-Depressive Association in Chicago, most patients reported their depression was not under complete control, even though they had been taking medications for 3 to 5 years. Almost half of the patients survey reported unwanted side effects, resulting in over 50% of them to stop antidepressants altogether.

Some general reported side effects of antidepressant Prozac-type medications (SSRIs) may include: weight gain, sexual problems, insomnia, diarrhea, headache and nausea. Conversely, for the older antidepressants (tricyclics) side effects may include: dry mouth, constipation, dizziness, blurred vision, and tremors. Which side-effects or medications do you prefer?

Surprisingly, overall patient responses or clinical effectiveness for antidepressant medications have not changed in over 50 years, despite marketing claims as being improved or better.

Newer antidepressants have proven to be no better than the older medications - only the side effects are different. Antipsychotic medications such as Haldol, Thorazine, Zyprexa, and Risperidal follow a similar pattern according to British medical research. Newer medications may in fact present with newer dangers. For example, GlaxoSmithKline the makers of the antidepressant drug Paxil (an SSRI) recently lost a 6.4 million dollar settlement after an American jury decided that the medication was largely to blame for a family killing. According to Harvard Medical School psychiatrist Joseph Glenmullen, these types of medications (SSRIs) may increase the risk of suicide, anxiety, and agitation.

Withdrawal reactions may also plague people who choose to discontinue their antidepressants. Withdrawal symptoms are a new and largely unknown problem of these antidepressant types (SSRIs). Symptoms generally begin within 1-2 days and can take up to 3 weeks or more to resolve. It is possible to confuse withdrawal symptoms with a depressive episode or relapse. The main signs are: dizziness, headache, nausea, and flu-like symptoms as well as anxiety, confusion, irritability, excessive dreaming and insomnia. For the antipsychotic or neuroleptic medications side effects are also equally concerning. For example, patients treated with moderate doses of antipsychotics (i.e. Clozaril) are at more than twice the risk for sudden cardiac death. Tardive dyskinesia, a troublesome neurological side effect of these medications can occur as quickly as one month after beginning treatment.

Even though the medications may statistically demonstrate degrees of benefit for mental illness sufferers, overall, people need to better informed of their potential limitations and risks. Remember, that fundamentally we do not know how these medications work. In addition, there are numerous people taking several types and combinations of psychiatric and other types of medications. The research in this area is poor and the risks and dangers are even more uncertain. Having said this, as I have already stated, psyhciatric medications are necessary for some patients and do have a place in our healthcare system.

Overall, it is important to investigate effective and safe approaches of treating mental illness. It is equally important to find potential triggers or to explore both conventional & unconventional reasons which may help explain the problem. For example, low cholesterol and tryptophan levels is associated with increased risk of suicide, infections that cause Strep throat can lead to obsessive compulsive disorder (OCD) and Tourette's syndrome in children, hormone imbalances can cause or worsen depression and anxiety. Remember, it's not all in your head. It is important to attain a holistic perspective when treating a mental imbalance.

Orthomolecular psychiatry

In general there are two treatment programs for treating mental illness: (1) standard treatment employed by nearly all psychiatrists which focuses on tranquilizers and antidepressant methods, and (2) orthomolecular therapy which focuses on providing substances normally present in the brain (i.e. nutrition) and removing those substances which do not belong (i.e. toxins).

Conventional treatment of mental illness typically reduces some symptoms. However, the ramifications of treatment are associated with a host of side-effects. Patients become apathetic and disinterested. On the physical side they develop tremors, hormone changes, frigidity or impotence, and weight gain. This is why it is so difficult to keep patients on these drugs. Here is where orthomolecular psychiatry provides support.

Nobel Prize winner Dr. Linus Pauling coined the term "Orthomolecular Medicine". He viewed diseases, in part, caused by imbalances of nutritional factors. The route word of orthomolecular is "ortho" which signifies "right" and "molecular" which signifies "molecules". When combined, the practice of Orthomolecular Medicine employs the proper (right) use of nutrients (molecules) in preventing & treating disease while removing obstacles to health.

A pioneer in the field of orthomolecular medicine, Dr. Abram Hoffer MD, PhD, applied these principles to the field of Psychiatry. Dr. Hoffer, a psychiatrist & researcher, was the first person to use vitamins for treating mental illness. He is famous for his work with Niacin (vitamin B3) in lowering cholesterol levels and treating schizophrenia. In fact, Dr. Hoffer established the very first double-blind, placebo-controlled study in the field of psychiatry back in the 1950s! With over 40 years of experience in this field of medicine, Dr. Hoffer has documented a 90% recovery rate in acute schizophrenia and a 70% recovery in chronic cases using vitamins & life style changes.

Over the years, the clinical application of nutrition in psychiatry has, for the most part, been ignored. Ironically, there are several documented research papers commenting on the clinical application of vitamins, minerals, amino acids, and proper fats in relation to mental illness. In fact, there are medical reports commenting on the use of intravenous vitamins for providing immediate relief in psychotic patients (no drugs!).

Benefits of Orthomolecular treatment

The application of orthomolecular psychiatric treatments is advantageous in mental health care. Reported benefits of treatment are numerous and include: enhanced responses to standard medications, reduced risks of brain damage and drug toxicities, reduction in relapse rates, and not inducing or replacing one psychosis for another (which is common with medications). The ultimate goal of orthomolecular treatment is to provide both mental & physical stability without additional risks & complications.

Vitamin B6 & tardive dyskinesia: it's about time!

Recently, in the September issue of the American Journal of Psychiatry vitamin B6 (aka. pyridoxine) demonstrated significant benefit for the troublesome movement disorder tardive dyskinesia (TD) 1.

For those people unfamiliar with this painful & crippling problem, TD is a neurological problem associated with antipsychotic or neuroleptic medications. Some abnormal movements characteristic of TD include grimacing, sticking out the tongue, smacking and sucking of the lips, and sometimes, rapid movements of the arms and legs. Recent evidence suggests that symptoms may begin as early as one month after beginning medications, affecting more than 1 in four older patients annually 2. The belief is these psychiatric medications cause some sort of change and/or damage to the brain & nervous system. Treatments are poor and involve additional medications (which also have their limitations).

In the B6 study of TD, fifteen patients with schizophrenia who met research criteria for tardive dyskinesia were randomly assigned treatment with either vitamin B6 or placebo for 4 weeks in a double blind cross over fashion. The patients were given 100mg of B6 daily, increasing weekly in 100 mg increments to a total of 400 mg/day by the fourth week. The study found significant improvements in various movement scores (i.e. parkinsonism, dystonia, and dyskenetic movement) beginning in the third week (at 300 mg/day). No adverse effects were noted. It is important to mention that B6 in TD is not new. One of the first positive reports of B6 for TD was a small study published in the Journal of Clinical Psychiatry back in 1978 3. Four out of 5 patients improved using 1000-1400 mg/day. Responses were noticed within as little as 1 week of treatment (as compared to 3 weeks in the previous study); the higher doses were well tolerated. Why has there been an over 20-year delay with this single vitamin and TD? Supporters of nutritional medicine have reported significant benefit not only with B6, but also with additional nutrients in TD. Kunin demonstrated dramatic results in treating TD with the mineral manganese and vitamin B3 4,5. Hawkins reported the successful prevention of TD in a total of 61,508 patients using vitamins B3, C and B6 6. These findings have yet to be explored in "mainstream" psychiatry journals. Several other nutrients such as vitamin E, lecithin, tryptophan, melatonin, & essential fatty acids have also demonstrated degrees of benefit in TD.

The findings reported in the American Journal of Psychiatry are long over due for such a devastating problem. Vitamin B6 is readily available, cheap, and safe. Higher doses (>400 mg/day) may have greater advantages for TD, however in such cases I recommend the supervision from a qualified healthcare provider. Along with B6, additional nutrients should be utilized for TD and also for its prevention. Nutritional medicines demonstrate lower side effect profiles and greater safety margins when compared to standard psychiatric & neuro-active medications. In addition to supporting neurotransmitter & hormone function, nutritional intervention help protect the body & brain from damaging medications, infections, environmental exposures, and other harmful agents.

References

1. Lerner V et al. Vitamin B(6) in the treatment of tardive dyskinesia: a double-blind, placebo-controlled, crossover study. Am J Psychiatry 2001;158(9):1511-4
2. Jeste, DV et al. Incidence of tardive dyskinesia in early stages of low-dose treatment with typical neuroleptics in older patients. Am J Psychiatry 1999; 156(2):309-311
3. DeVeaugh-Geiss J, Manion L. High-dose pyridoxine in tardive dyskinesia. J Clin Psychiatry 1978;39:575-75
4. Kunin RA. Manganese and niacin in the treatment of drug-induced dyskinesias. J Orthomolecular Psychiatry 1976;5(1):4-27
5. Hoffer, A. Tardive dyskinesia treated with manganese. CMAJ 1977;117:850
6. Hawkins DR. Successful prevention of tardive dyskinesia. J Orthomolecular Medicine 1989;4(1):35-36