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Nutritional Protection from
the
Damaging Effects of Psychiatric Drugs
by Charles Gant, M.D., Ph.D., East Syracuse, NY
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Regarding the
complementary use of nutritional supplements and psychotropic
medications, many psychiatric patients seem to be unable to
discontinue medications without incurring withdrawal side
effects and many want to stay on medication believing,
sometimes rightly, that recurrence of psychiatric symptoms are
prevented.
In my practice when I evaluate someone taking psych meds, I
initially usually do not change any medication dosages and
proceed to do the testing and then design treatments that make
medications unnecessary. In the meantime I quickly focus on
mitigating neuronal injury in two ways, antioxidants therapies
and phospholipid/essential fatty acid therapies. The former is
a no-brainer as oxidative stress, especially when toxic
substances are in contact with cells, is always an issue. For
instance, vitamin E is probably the most important and I
immediately prescribe it in the dosage ranges of 800 IU to
1600 IU a day. |See:
Am J Psychiatry.1991 Feb;148(2):279. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=
Retrieve&db=pubmed&dopt=Abstract&list_uids=1987837
Vitamin E in the treatment of tardive dyskinesia. Elkashef AM,
Ruskin PE, Bacher N, Barrett D. Department of Psychiatry,
Baltimore VA Medical Center, MD.
Eight subjects with persistent tardive dyskinesia were treated
with vitamin E and placebo in a randomized, double-blind
crossover study. Their mean score on the Abnormal Involuntary
Movement Scale (AIMS) was significantly lower after treatment
with vitamin E than after placebo administration.
I am assuming that if vitamin E can assist is in reversing TD
then it probably could help prevent any neurological injury.
Of course, it works best if combined with other antioxidants,
such as vitamin C, CoQ10, a source of zinc and selenium etc.
The other factor in preventing neuronal injury that is often
overlooked, is essential fatty acids and phospholipids. These
would be expected to work as:
1) They are high-energy, basic structural and functional
elements of all biological membranes,such as
cells, blood corpuscles, lipoproteins, and
surfactants.
2) They are indispensable for cellular differentiation,
proliferation, and regeneration.
3) They maintain and promote the biological activity of many
membrane-bound proteins and receptors.
4) They play decisive roles in the activity and activation of
numerous membrane-located enzymes, such as sodium - potassium
- ATPase, adenylate cyclase, and lipoprotein lipase. They are
important for the transport of molecules through membranes.
5) They control membrane-dependent metabolic processes between
the intracellular and intercellular space.
6) The polyunsaturated fatty acids contained in them, such as
linoleic acid, are precursors of the cytoprotective
prostaglandins and other eicosenoids.
7) As choline and fatty acid donors, they have an influence in
certain neurological processes (probably due to enhancement of
neuroplasticity).
8) They emulsify fat in the gastrointestinal tract.
9) They are important emulsifiers in the bile.
10) They codetermine erythrocyte and platelet aggregation.
11) They influence immunological reactions on the
cellularlevel.
(from Cerv, G and Paltauf, F.(editors): Phospholipids:
Characterization, Metabolism And Novel Biological
Applications. AOCS Press, Champaign, Ill., 1995, pp.209-227
(Chapter 19, Gundermann, K.F., author).
After some early reports on the benefits of phosphatidyl
choline, later studies were surprisingly disappointing.
See: (J Clin Psychiatry 1990 Apr;51(4):149-53, A
crossover study of lecithin treatment of tardive dyskinesia.
Gelenberg AJ, Dorer DJ, Wojcik JD, Falk WE, Brotman AW, Leahy
L. Department of Psychiatry, University of Arizona College of
Medicine, Tucson 85724.)
The problem here, as always, is "magic bullet"
thinking, the search for the one intervention that works. If
these researchers were interested in generating acetylcholine
to downregulate dopamine, it would have been nice to supply
pantethine (activated vitamin B5) so that the choline could
actually be acetylated. Also, if these researchers were more
interested in the structural (not neurotransmitter precursor)
effects of phospholipids, it would have been nice to study the
far more important phospholipid in the brain, phosphatidyl
serine (PS), not phosphatidyl choline (PC). Despite the
extensive evidence that PS prevents memory loss, I can not
find references regarding TD or neuronal protection using PS.
The other two main phospholipids, inositol and ethanolamine
likewise have not been studied either that I can find, despite
some promise of inositol for depression, panic disorder and
OCD. See:
J Clin Psychopharmacol 2001 Jun;21(3):335-338, Double-blind,
controlled, crossover trial of inositol versus fluvoxamine for
the treatment of panic disorder. Palatnik A, Frolov K, Fux M,
Benjamin J. Ministry of Health Mental Health Center, Faculty
of Health Sciences, Ben Gurion University of the Negev,
Beer-Sheba, Israel.
The reason that phospholipids may not help as much with
neuronal protection as might be expected may be that the
polyunsaturated fatty acids of these soy-derived phospholipids
are mostly omega 6, not omega 3. Especially in light of the
omega 3 studies in depression, I have therefore prescribed
lots of distilled salmon oil along with the phospholipids (PC
and PS), as fatty acids are readily exchanged in phospholipid
molecules and the omega 3s are thus incorporated into cell
membranes via PS and PC. Also, as I have now reviewed hundreds
of essential fatty acid analyses on patients, it seems
important to also add flax oil to discourage the elongase and
other enzymes from converting any additional omega 6 oils that
are already in abundance with PC and PS supplementation. So
the protocol (subject to genotype variations) that should
protect all psych patients on meds and is unlikely to hurt
anyone is:
1) Antioxidants galore as above
2) Phosphatidyl serine 200 mg. twice a day
3) Purified soy lecithin 1000 mg. twice a day (higher doses
can be used in non-dopamine deficient patients, e.g.,
catecholamine deficiency, Parkinsons)
4) Flax oil - 2000 mg. twice a day
5) Distilled fish oil - 2000 mg. twice a day
I hope this helps for those with questions about what
nutrients they can take to help protect them from the long
term side effects of psych meds. This protocol is also helpful
for those who are no longer on psych meds but may still be
suffering from the previous injury due to them. Also, in kids
or for those who cannot swallow pills well, these capsules can
be opened up, the contents mixed and massaged into the skin.
Phospholipids are also used in transdermal delivery of drugs
and carry all the oils rapidly into the body.
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