by Charles Gant, M.D., Ph.D., East Syracuse, NY
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.