Orthomolecular psychiatry

Orthomolecular psychiatry is a branch of orthomolecular medicine whose proponents claim that dietary supplements and other treatments can be effective in treating mental illness.

Mainstream medical experts agree that some nutritional and dietary supplements have value in treating mental illness, such as the use of omega 3 fatty acids with bipolar disorder.^[1] The earliest assertions by proponents of orthomolecular psychiatry, whose claims were emphatically endorsed by Nobel Laureate chemist Linus Pauling,^[2] were rejected in 1973 by a panel of the American Psychiatric Association,^[3] 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.^[4] Orthomolecular psychiatry subsequently found scant support among, and endured many accusations of quackery by, mainstream psychiatrists.

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History

The origins of orthomolecular psychiatry can be traced to as early as 1927.^[5] 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,^[6] and Linus Pauling.^[7]

Diagnoses, treatments, and scope

Proponents of orthomolecular psychiatry claim to have identified the causes of some psychiatric syndromes, particularly of those that cause psychosis; testing for these causes guides diagnosis and treatment. These include pyroluria, histadelia (elevatedhistamine 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.^[8] Diagnostic measures and therapies commonly employed include individual biochemical workup, fasting, identifying allergies, dietary changes, megavitamin therapy, aminoacids, and other pharmacologic nutrients.^[8] 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.^[8] Not infrequently, the improvements orthomolecular psychiatrists can adduce are sufficient to allow patients to reduce, but not eliminate, their reliance on conventional psychotropics.

Hoffer and Osmond developed and used the "HOD test" as well as biochemical research to identify and monitor schizophrenia patients' progress, much different methods than the testing and patient selection used by the American Psychiatric Association. The use of the 'niacin flush' to evaluate patients is also being explored.^[9] Many orthomolecular physicians still prescribe antipsychotics for schizophrenic patients, initially. However, the long-term avoidance of antipsychotics, which are notorious for side-effects such as tardive dyskinesia, and a return to health is the main goal. The orthomolecular practice of weaning off conventional neuroleptic drugs^{[citation needed]} follows Dr. Carl Pfeiffer's dictum known as "Pfeiffer's Law" that states, "For every drug that benefits a patient, there is a natural substance that can achieve the same effect".^[10]

These and other methods have been claimed to treat Alzheimer's disease,^[11] dementia,^[11] tardive dyskinesia,^[12] bipolar disorder^[13] and schizophrenia.^[8]

Criticisms

Orthomolecular psychiatry is controversial, having been rejected by the mainstream medical community. 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^[14] and American Academy of Pediatrics^[15] 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^[3] (the earliest version of treatment, ca. 1952) for a different kind of patient population, 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.^[14]

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.";^[4] compared with a basic, modern orthomolecular regimen.

Proponents consider the 1973 APA task force report error laden with sweeping, scientifically unfounded conclusions,^[3] highly politicized, and that its studies failed to use similar methods, materials and subjects as the original work.^[16] 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.^[17] 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 ^[18] and an extensive biochemical research program.^[19] 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^[18] favorably with respect to orthomolecular psychiatry, obtaining the same result as Hoffer,^[20] and never received NIMH or APA support again.^[21] Another of the APA report's authors, then NIMH member Loren Mosher, later resigned from the American Psychiatric Association in total disgust,^[22] and referred to the organization as a "drug company patsy."^[23]

Current research

Food allergies

Orthomolecular psychiatry has not been studied extensively by mainstream science. Despite this, there is some evidence that specific hypotheses of practitioners have merit, and one of their hypotheses is being investigated in similar contexts. A 2006 literature review found that the removal of gluten from the diet of a subset of schizophrenic patients resulted in a drastic reduction of symptoms.^[13] Removing gluten had long been recommended by orthomolecular psychiatrists when indicated.^[8][24] J. Robert Cade, the inventor of Gatorade and an academic physician at the University of Florida found links between certain foods and autism and schizophrenia.^[25]

Copper

Until recently, the scientific consensus was that the only illness causing dementia involving an accumulation of copper to toxic levels was Wilson's disease. Carl Pfeiffer reported 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;^[24] his beliefs were dismissed by the mainstream medical community. More recently there has been considerable interest in, and initially considerable controversy around, the theory that at least some cases of Alzheimer's disease are caused by a toxic buildup of copper in the brain, and an effort to bring a medication to market that removes copper from the brain as a treatment for these cases,^[26] a development that does not prove Pfeiffer's histapenia claims. 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.^[27], and that males with a history of violence and assault have a significantly higher median blood copper / zinc ratio.^[28]

Violent and delinquent behavior

William Walsh of the Pfeiffer Treatment Center has dedicated himself to investigating the causes of violent and delinquent behavior using the diagnostics of orthomolecular psychiatry, with promising results.^[8]

Notable patients

Abram Hoffer reports that actress Margot Kidder credits orthomolecular psychiatry with helping her overcome bipolar disorder.^[29] Kidder lobbied successfully for the creation of the first public clinic that provides treatment according to the precepts of orthomolecular medicine, in Kent, Washington.^{[citation needed]} Mark Vonnegut attributed his recovery from schizophrenia to orthomolecular psychiatry and advocated its adoption by mainstream medicine, but later chose to disavow his statements.^[8]

References

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; Hawkins, D MD (1973). Orthomolecular Psychiatry: Treatment of Schizophrenia. San Francisco: Freeman, 697. 
• 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.