Orthomolecular psychiatry

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

Though mainstream medical experts agree that some nutritional and dietary supplements have value in treating mental illness (see the omega 3 fatty acid page for an example), the sometimes sweeping claims of orthomolecular psychiatry proponents have found little support among mainstream medical experts.[1]

Contents

[edit] History

The origins of orthomolecular psychiatry can be traced as early as 1927[2].

However orthomolecular psychiatry per se is 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[3] and Linus Pauling.

[edit] Orthomolecular psychiatry treatments and scope

Specific techniques commonly employed include individual biochemical workup, dietary measures, fasting, Megavitamin therapy, and identifying allergies.

Hoffer and Osmond developed and used the "HOD test" to identify and monitor schizophrenia patients' progress, using a much different method than the testing used by the American Psychiatric Association. A more recent development in orthomolecular psychiatry applies the "niacin flush" concept dermally to identify and evaluate patients biochemically.[4]

Many orthomolecular physicians still prescribe neuroleptics, initially. However, the long-term avoidance of neuroleptics is the main goal. "Pfeiffer's Law" (actually a dictum), states, "For every drug that benefits a patient, there is a natural substance that can achieve the same effect."

These and other methods have been claimed to treat alcoholism, drug addiction, anxiety, autism, clinical depression, hyperactivity, ADHD, Alzheimer's Disease, mental retardation, senility, bipolar disorder and schizophrenia.

[edit] Criticisms

As of 2005, orthomolecular psychiatry remains controversial, with little support among the mainstream medical community. Critics have noted that the claims of proponents are considered unsubstantiated by conventional psychiatry. Conventional authoritative bodies such as the National Institute of Mental Health[citation needed] and American Academy of Pediatrics[5] have historically 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[6] (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.

According to a Beersheva Mental Health Center study begun in 2005 and ongoing as of 2007,

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

Harvard-trained pediatrician Mark Vonnegut discusses orthomolecular psychiatry in his memoir The Eden Express; he advocated the use of orthomolecular psychiatry but later disavowed it.

[edit] Rebuttals

Proponents consider the 1973 APA task force report error laden with sweeping, scientifically unfounded conclusions,[6] highly politicized, and that its studies failed to use similar methods, materials and subjects as the original work.[8] 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.[9] 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 [10] and an extensive biochemical research program.[11] One of the APA report's six authors, psychologist JR Wittenborn, reacting to Hoffer's specific criticisms, later re-analyzed his original double blind study[12] favorably with respect to orthomolecular psychiatry, obtaining the same result as Hoffer,[13] and never received NIMH or APA support again.[14] Wittenborn's latter report also goes unquoted by critics. Another of the APA report's authors, then NIMH member Loren Mosher, later resigned from the American Psychiatric Association in total disgust,[15] which he also called a "drug company patsy." [16]

[edit] Approving References to Methods Associated with Orthomolecular Psychiatry by Mainstream Researchers

A recent literature by scientists at Johns Hopkins University confirms that the removal of gluten from the diet of schizophrenics is a viable therapy in some cases of schizophrenia. They wrote: "A drastic reduction, if not full remission, of schizophrenic symptoms after initiation of gluten withdrawal has been noted in a variety of studies. However, this occurs only in a subset of schizophrenic patients." [17]

[edit] References

  • Abram Hoffer, Morton Walker (2002) Smart Nutrients: Prevent and Treat Alzheimer's, Enhance Brain Function, CCNM Press, ISBN 1-890612-26-X
  • Abram Hoffer (July 2004) Healing Schizophrenia: Complementary Vitamin & Drug Treatments, CCNM Press, ISBN 1-897025-08-4
  • Abram Hoffer (2004) Healing Children's Attention & Behavior Disorders: Complementary Nutritional & Psychological Treatments, CCNM Press, ISBN 1-897025-10-6
  • Eva Edelman (2001) Natural Healing for Schizophrenia: And Other Common Mental Disorders, Borage Books; 3rd Rev ed, ISBN 0-9650976-7-6
  • Eric Braverman, Carl Pfeiffer, K. Blum, R. Smayda (2003) The Healing Nutrients Within: Facts, Findings, and New Research on Amino Acids, 3rd ed, Basic Health Publications, ISBN 1-59120-037-7
  • Carl C. Pfeiffer (1988) Nutrition and Mental Illness : An Orthomolecular Approach to Balancing Body Chemistry, Healing Arts Press, ISBN 0-89281-226-5
  • Birkmayer JGD & Birkmayer W, "The coenzyme nicotinamide adenine dinucleotide (NADH) as biological antidepressive agent. Experience with 205 Patients.", New Trends in Clinical Neuropharmacology, 5:19-25, 1991.
  • Melvyn R. Werbach (1999) Nutritional Influences on Mental Illness, 2nd edition, Third Line Press, ISBN 0-9618550-8-8

[edit] External links

[edit] See also

[edit] Footnotes

  1. ^ "Orthomolecular Therapy" by Stephen Barrett, M.D. URL accessed February 12, 2007
  2. ^ Reiter PJ: Behandlung von Dementia Praecox mit metallsalzen. Mangan. Z. Neur., 108:464-480, 1927 As quoted in Carl C. Pfeiffer, Ph.D., M.D. and Scott LaMola, B.S. Zinc and Manganese in the Schizophrenias, Journal of Orthomolecular Psychiatry, Vol. 12, No. 3, 1983
  3. ^ David Horrobin Bibliography
  4. ^ Niacin Abnormalities, The Ness Foundation
  5. ^ "Vitamin and Mineral Supplementation in Down's Syndrome", by Forrest C. Bennett MD, et al., URL accessed February 13, 2007
  6. ^ a b Linus Pauling, On the Orthomolecular Environment of the Mind: Orthomolecular Theory, American Journal of Psychiatry 131:1251-1257, November 1974 Pauling argues the APA Task Force neglected to include vitamins B6 and C; overlooked positive niacin results (small test group, statistically not significant); used substoichimetric, chemically inadequate amounts of niacin to overcome spiked methionine in another test
  7. ^ Treatment of Acute Schizophrenia With Vitamin Therapy, Beersheva Mental Health Center, 2005
  8. ^ Megavitamin Therapy In Reply To Task Force Report on Megavitamin and Orthomolecular Therapy in Psychiatry. Canadian Schizophrenia Foundation. August 1976
  9. ^ Abram Hoffer, Adventures in Psychiatry: The Scientific Memoirs of Dr. Abram Hoffer, KOS Publishing, Toronto, 2005 Review
  10. ^ Wittenborn JR, Weber ESP & Brown M: Niacin in the long term treatment of schizophrenia. Arch Gen Psychiatry 28:308-15, 1973.
  11. ^ [1] A Hoffer, H. Osmond, The Adrenochrome Hypothesis, J Orthomolecular Medicine, Vol 14, No. 1, 1999
  12. ^ Wittenborn JR, Weber ESP & Brown M: Niacin in the long term treatment of schizophrenia. Arch Gen Psychiatry 28:308-15, 1973.
  13. ^ Wittenborn JR: A Search for Responders to Niacin Supplementation. Arch Gen Psych 31:547-552, 1974
  14. ^ [2] Abram Hoffer, The Vitamin Paradigm Wars, Townsend Letter for Doctors and Patients, June 1996
  15. ^ [3] Loren R. Mosher, M.D. to Rodrigo Munoz, M.D., President of the American Psychiatric Association (APA), Letter of Resignation from the American Psychiatric Association, 4 December 1998
  16. ^ [4] obituary for Loren Mosher, Washington Post, July 2004
  17. ^ Kalaydjian AE, Eaton W, Cascella N, Fasano A (2006) The gluten connection: the association between schizophrenia and celiac disease. Acta Psychiatr Scand. 2006 Feb;113(2):82-90.
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