by Craig Olson
Member since:
January 19, 2006

Controversies in Psychiatry

August 05, 2009 12:48 PM EDT
views: 171 | comments: 3

“All truth passes through three stages:

First, it is ridiculed;

Second, it is violently opposed;

Third, it is accepted as being self–evident.”

— Arthur Schopenhauer

German philosopher

 

"It’s safe to say that we know that metabolic changes in the brain are present for all major mental illnesses.”

St. Louis psychiatrist Charles Conway

"Shock treatment is not good for your brain." John Friedberg, M.D. neurologist, Berkeley, CA

Introduction
  Controversies abound in psychiatry. One of the battles is over whether or not there are chemical imbalances. There are indeed chemical imbalances in mental diseases. Do not get your science from Tom Cruise. Cruise is a brilliant actor, but knows very little about psychiatry. 
The Null Hypothesis
  Dr. Gary Null reports a "food-mood connection". He advocates "nutritional and environmental approaches to mental health and physical wellbeing". Null has appeared on public television. He has also written an article in the Journal of Orthomolecular Medicine as well as writing books. Null recommends certain supplements for depression.
The Fish Oil Theory
  "I propose that a rational combination of omega-3 and omega-6 fatty acids is as beneficial as that of the "polypill"; and may even show additional benefit in the prevention of depression, schizophrenia, Alzheimer's disease, and enhance cognitive function." 

Das UN.

UND Life Sciences, 13800 Fairhill Road, #321, Shaker Heights, OH 44120, USA. undurti@hotmail.com

  This quote is from Ref. 1. Although I do not favor this theory, the treatment is thought to have beneficial cardiovascular side effects. The "polypill" contains prescription drugs for cardiovascular problems.

"Essential fatty acids (EFAs) and their long-chain metabolites and other products prevent platelet aggregation, lower blood pressure, reduce LDL-C, and ameliorate the adverse actions of homocysteine." Das UN

The Homocysteine Theory

  This is a fairly recent theory for schizophrenia. The theory is not completely different from Null's views. Ref. 2 from Israel recommends the use of B vitamins.

Other Amino Acids

  There is an orthomolecular theory that certain beneficial amino acids can be used as treatments. Ref. 3 supports this theory.

Psychiatric Drugs

  Almost every possible side effect known to man has been seen with psychiatric drugs (4) including dermatology problems (5).

Tryptophan

  Tryptophan theories abound in psychiatry (6, 7, 8, 9, 10). A hypermetabolism of tryptophan has been seen.

"The upregulation of the initiating step of the kynurenine pathway was demonstrated in postmortem anterior cingulated cortex from individuals with schizophrenia and bipolar disorder." 

Myint AM, Kim YK, Verkerk R, Park SH, Scharpé S, Steinbusch HW, Leonard BE.

Department of Psychiatry and Neuropsychology, University of Maastricht, The Netherlands.

  The above quote is from Ref. 7.
  Ref. 11 suggests "pharmacological manipulation". However, tryptophan is found in the diet. My own view is that a diet very low in tryptophan might be helpful. 
Orthomolecular Psychiatry
  One of the most lively controversies has been the one over orthomolecular psychiatry. This is very controversial because the drug companies, which pay a lot of money to the medical journals, do not make any money off of this method of treatment. Therefore those with financial connections to the drug companies are opposed to it. Refs. 12-18 explain orthomolecular psychiatry, which is very similar to the views of Gary Null.
Conclusions
  One of the reasons orthomolecular medicine has not been that popular is that one can't make a killing with it. Natural body substances can't be patented. The drug companies are out to make a killing.
  However, orthomolecular medicine is cheaper, safer, and more logical than drugs. There have been terrible problems with drugs. Many of these drugs are invented by trial & error. Rational drug treatments are lacking in psychiatry because the drug companies don't understand the chemical imbalances.
  If you're going to treat by trial & error, it is safer to make errors with natural body substances such as amino acids. However, the best approach is to figure out what the imbalances are and try to correct them. There appears to be an excess of tryptophan metabolism. It would make sense to try to correct this by a diet. The brain may be allergic to tryptophan in mental diseases.
References
1. Do polyunsaturated fatty acids behave like an endogenous "polypill"?

Das UN.

Med Hypotheses. 2008;70(2):430-4. Epub 2007 Jul 10.

2. Homocysteine-reducing strategies improve symptoms in chronic schizophrenic patients with hyperhomocysteinemia.

Levine J, Stahl Z, Sela BA, Ruderman V, Shumaico O, Babushkin I, Osher Y, Bersudsky Y, Belmaker RH.

Biol Psychiatry. 2006 Aug 1;60(3):265-9. Epub 2006 Jan 17.

3. N-acetylcysteine, a glutamate modulator, in the treatment of trichotillomania: a double-blind, placebo-controlled study.

Grant JE, Odlaug BL, Kim SW.

Arch Gen Psychiatry. 2009 Jul;66(7):756-63.

4. Aripiprazole-induced hiccups: a case report.

Ray P, Zia Ul Haq M, Nizamie SH.

Gen Hosp Psychiatry. 2009 Jul-Aug;31(4):382-4. Epub 2008 Oct 28. Review.

5. J Clin Psychopharmacol. 2008 Apr;28(2):219-20. Photo-onycholysis caused by olanzapine and aripiprazole.Gregoriou S, Karagiorga T, Stratigos A, Volonakis K, Kontochristopoulos G, Rigopoulos D.

6. Cytokine changes and tryptophan metabolites in medication-naïve and medication-free schizophrenic patients.

Kim YK, Myint AM, Verkerk R, Scharpe S, Steinbusch H, Leonard B.

Neuropsychobiology. 2009;59(2):123-9. Epub 2009 Apr 22.

7. J Affect Disord. 2007 Sep;102(1-3):65-72. Epub 2007 Jan 30. Links

Tryptophan breakdown pathway in bipolar mania.Myint AM, Kim YK, Verkerk R, Park SH, Scharpé S, Steinbusch HW, Leonard BE.

8. Brain Res. 2006 Feb 16;1073-1074:25-37. Epub 2006 Jan 30. Upregulation of the initiating step of the kynurenine pathway in postmortem anterior cingulate cortex from individuals with schizophrenia and bipolar disorder.Miller CL, Llenos IC, Dulay JR, Weis S.

9. Neurobiol Dis. 2004 Apr;15(3):618-29. Expression of the kynurenine pathway enzyme tryptophan 2,3-dioxygenase is increased in the frontal cortex of individuals with schizophrenia.Miller CL, Llenos IC, Dulay JR, Barillo MM, Yolken RH, Weis S.

10. J Psychopharmacol. 2009 May;23(3):287-94. Epub 2008 Jun 18. Kynurenine pathway in psychosis: evidence of increased tryptophan degradation.Barry S, Clarke G, Scully P, Dinan TG.

11. Pharmacological manipulation of kynurenic acid: potential in the treatment of psychiatric disorders.

Erhardt S, Olsson SK, Engberg G.

CNS Drugs. 2009;23(2):91-101. doi: 10.2165/00023210-200923020-00001. Review.

12. www.associatedcontent.com/article/1990392/advances_in_brain_research_psychiatry.html
13. http://www.associatedcontent.com/article/237845/the_link_between_food_allergies_and.html

14. www.associatedcontent.com/article/1932938/disease_biomarkers_in_psychiatry.html

 
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Comments: 3

M.K. Mueller Aug 5, 2009, 1:32pm EDT
In my experience with 10+ years of major depression is that yes, psychiatric drugs lots of side effects. However each person and their doctor need to decide if the medical benefits outweigh the side effects. In some cases the answer is yes and in some cases no.

I can also say that there is no silver bullet treatment. 2 people with similar severity of condition may respond differently to different treatments My doctor's tried many different anti-depressant medications on me for many years before finally finding 1 drug that finally treats my condition.

Similarly non-pharmaceutical treatments are going to work differently for different people. I know people with mild depression & anxiety that successfully treat it with St. John's Wort. However for myself I wouldn't trade my anti-depressant for a natural remedy. I've tried too many un-successful treatments to want to mess around with it now.
Craig Olson Aug 6, 2009, 9:24am EDT
My experience is that St. John's wort doesn't work. There is no reason why it should work. Nobody has a deficiency of St. John's wort. However, I have not heard any complaints about side effects from it. I am skeptical of herbal medicine because it isn't scientific enough. Nutrition is more scientific.
Ed Da Head Toker Aug 26, 2009, 7:18am EDT
st johns wort is a diuretic, which causes your veins to expand, your blood flows faster, and all medicine to be flushed out of your system like ex lax helps the feces come out faster.
It can cause blood clotting issues. And a possible hemophiliac type reaction.
Now you have 2 side effects of st johns wort.

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