Lead story: Multi-nutrients - an expert panel discusses what we know and what we don't know.

Also in this issue: That time of year again, SSRIs and GI bleeding, Thyroid and depression, Melancholic vs atypical depression, Symbiax for Rapid-cycling, Improving BP cognition, Long-term Celexa, Celexa for SAD, Quick acting Remeron, Serzone FDA lawsuit, BP kids, BP creativity put to the test, Male and female brains, Viagra lets down women, Gay and lesbian health concern, Cracking Up, Jayson Blair, Britney Spears, McMan's Web, Donations.

Multi-Nutrients for the Head

"Leave your drugs in the chemist’s pot if you can heal the patient with food." Hippocrates.

In a study published in the July 2002 British Journal of Psychiatry, 172 young adult prisoners in maximum security were given supplements of vitamins and minerals roughly equating to the US recommended daily allowance (RDA), plus fatty acids. The average time for those staying in the study was 146 days. While there was no change in the placebo group, there was a 35.1 percent drop in antisocial behavior for those taking supplements for at least two weeks and a 37 percent drop in violent offenses.

Speaking at a symposium, "Mineral/Vitamin Modification of Mental Disorders and Brain Function" (on audio tape) at the 2003 American Psychiatric Association’s annual meeting, the study’s lead author, Bernard Gesch CQSW of Oxford, noted that crime has increased seven-fold in the last 50 years. Over the same period of time, he reported, the trace element content in fruits and vegetables appears to have fallen significantly. According to the Centers for Disease Control, 79 percent of high school students eat less than five fruits or vegetables a day, and it is estimated that the ratio of omega-6 to omega-3 intake has increased six-fold since Paleolithic times.

The RDA was never meant to be regarded as optimal, more than one speaker reminded those at the same symposium. Instead, it is the minimum considered to prevent diseases such as scurvy or beriberi. According to a review article by Fairfield and Fletcher published in the June 19, 2002 JAMA, "most people do not consume an optimal amount of all vitamins by diet alone."

At the same session, David Benton PhD of the University of Wales, Swansea, cited his 1991 study where those who took 50 mg of thiamin (Vitamin B1) - nearly 50 times the RDA - reported improved moods and exhibited faster reaction times, with no change in the placebo group. The study population (female undergrads) were all well-nourished with no mood disorders. In another study, those on 100 mcg of the trace mineral selenium - twice the RDA - reported less depression, anxiety, and tiredness following five weeks than the control group. Finally, a 1995 study on young healthy adults found that 10 times the recommended doses of nine vitamins after 12 months resulted in improved performance on a range of cognitive functions in the females but not the males.

Dr Benton related that the brain is arguably the most nutritionally sensitive organ in the body, playing a key role in controlling bodily functions. It is the most metabolically active organ, with two percent of the body’s mass accounting for 20 percent of basal metabolic rate. With millions of chemical processes taking place, he went on to say, if each of these is only a few percent below par, it is easy to imagine some sort of cumulative effect resulting in less than optimal functioning.

Added Bonnie Kaplan, PhD of the University of Calgary: "We know that dietary minerals and vitamins are necessary in virtually every metabolic action that occurs in the mammalian brain." In Dec 2001, she published an open pilot study in the Journal of Clinical Psychiatry involving 14 bipolar patients who were placed on a commercial supplement, EM Power, concurrent with their meds. Thirty-three of the 36 ingredients in the supplement are megadoses of vitamins and minerals. After 44 weeks, depression scores dropped by 55 percent and mania scores by 66 percent. Most patients were able to lower their meds doses by 50 percent. Two were able to replace their meds with the supplement Three dropped out after three weeks.

In the same issue of the JCP, Charles Popper MD of McLean Hospital and Harvard reported success on 19 of 22 patients he treated with the supplement.

Dr Kaplan was quick to point out that neither she nor the other speakers on the panel were saying that nutritional deficiencies are the only cause of mental illness, nor nutritional supplements the only treatment. Unfortunately, our limited knowledge is likely to remain that way unless several things change, more than one speaker noted. For example, there is an institutional bias against studying more than one ingredient at a time, which dooms proposals for large- scale randomized control trials for multi-vitamins and minerals to death by red tape. Thus, despite some tantalizing preliminary findings, multi-nutrients for mood disorders remains a long way from being proven. Watch this space ...

Toxicity and Other Concerns

Dr Popper, who co-chaired the APA symposium, observed that while nutrient supplements are probably safer than psychiatric drugs, one should be mindful of toxic levels and special circumstances. For example, high doses of vitamin A need to be avoided in pregnant women owing to risk of fetal harm.

The issue of interactions with meds was raised, but Dr Kaplan expressed her dissatisfaction with the term, interaction. Her theory is that nutritional supplements may improve the performance of metabolic pathways, thus amplifying the positive and negative effects of meds. As a result, therapeutic doses of meds can become overdoses. Truehope, the nonprofit arm of Synergy that manufactures EM Power, advises that new users will experience initial side effects from their meds thanks to the amplification factor, and urges patients to work with their doctor in lowering their meds dose.

Caution

Please don’t interpret anything in the lead article as carte blanche to experiment on yourself. Any treatment decisions concerning nutrients should be made in partnership with your psychiatrist.

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SSRIs and GI Bleeding

SSRIs should be avoided or used with caution in at risk patients, the UK Consumers’ Association advises in its journal, Drug and Therapeutics Bulletin. The report is based on a study of 11,650 patients, which found that those who suffered gastrointestinal bleeding were three times more likely to have been prescribed SSRIs in the past 30 days. The risks were even greater for those who took Aspirin with SSRIs or for patients over age 80.

Last December, UK regulators told doctors not to prescribe most SSRIs to children based on a report in the Drugs and Therapeutics Bulletin.

Thyroid and Depression

A Greek/Danish study of 30 meds-free depressed patients and 60 controls has found that although overt thyroid dysfunction is not common in depressed patients, with no significant differences in thyroid function amongst depressed subtypes, depressed patients had higher "thyroid binding inhibitory immunoglobins," (TBII) which can inhibit the functioning of the thyroid gland. Those with atypical features had significantly higher "thyroid microsomal antibodies." By creating algorithms based on indicators of thyroid function, the researchers predicted which subjects suffered from depression in 80 percent of cases, could moderately differentiate between subtypes, and predicted patients’ response to antidepressants over two years at a success rate of 89.5 percent. Higher TBII was linked to lower response to treatment.

Melancholic vs Atypical Depression

In their article on the above study, the authors contrasted melancholic vs atypical depression, noting that the two subtypes are traditionally classified into opposite poles. In melancholia, the authors note, the autonomous nervous system and the stress response seem hyperactive. Patients are anxious, dread the future, lose responsiveness to the environment, have insomnia, lose appetite, ... with depression at its worst in the morning." The stress hormone CRH may seem hyperactive while growth hormone and reproductive axes may be diminished. Patients with atypical depression, by contrast, tend to be "lethargic, fatigued, hyperphagic [leaden], hypersomniac, reactive to the environment, and [are] ... best in the morning." There may be a down regulation of the HPA axis, with CRH deficiency.

Quiz

What is the number one health concern in the gay and lesbian community? Answer further down.

ISBD Conference

The following three studies were unveiled at the International Society for Bipolar Disorders regional group conference in Sydney last month:

Symbyax for Rapid-Cycling

An Eli Lilly secondary analysis of 315 patients with a history of rapid-cycling on combination Zyprexa-Prozac (marketed as Symbyax for bipolar depression) has found that 77.8 percent responded and 34.3 percent remitted after eight weeks vs Zyprexa alone (35.7 and 10.6, respectively) and a placebo (39.4 and 16.3). Treatment-emergent mania occurred in 9.7 percent of the combination group, 8.5 of the Zyprexa alone group, and 4.2 percent of the placebo group.

Improving BP Cognition

Cognitive impairment has been associated with the neurotoxic effects of repeated mood episodes in bipolar. A Cambridge (Massachusetts) Hospital chart review of four bipolar I patients with severe cognitive dysfunction (mainly short and long-term memory impairment and word-finding difficulty) found that the two on higher doses (24/mg and 32/mg a day) of the Alzheimer’s drug Reminyl (galantamine) "experienced marked cognitive improvement" vs the two on lower doses (8mg/day). The drug was well-tolerated.

The Van Gogh Factor

A Brazilian study of 63 volunteers divided between bipolar patients who were well, relatives of bipolar patients, and healthy controls has found that although the bipolar and bipolar relatives groups came from higher social classes than the controls, there was no difference in creativity and IQ between the three groups.

Celexa for the Long Term

A Forest Laboratories study of 274 depressed patients who had responded to eight weeks of open-label treatment on Celexa were given either the same drug or a placebo for another 36 weeks. During the double blind phase, 26 percent of the Celexa patients relapsed into depression vs 40 percent of those on a placebo. Four percent of the Celexa patients discontinued treatment due to adverse events vs seven percent of the placebo group.

Celexa for SAD

A Danish study of 269 patients with seasonal affective disorder has found that those continuing on Celexa for 15 weeks experienced fewer relapses than those continuing on a placebo (17.1 percent vs 33.7 percent).

Quick Acting Remeron

An Organon meta-analysis of 12 trials involving 2,970 depressed patients has found that those on Remeron had a 49 percent probability of achieving an early response during the first three weeks of treatment and a 58 percent greater chance of achieving a sustained response in the same period than those on SSRIs

Serzone FDA Lawsuit

The consumer group Public Citizen is suing the FDA for not acting on its petition to ban Serzone. The drug has been removed from Canadian and European markets and will be taken off the market in New Zealand and Australia in May. The drug’s labeling carries the following black box warning:

"Cases of life-threatening hepatic failure have been reported in patients treated with Serzone. The reported rate in the United States is about one case of liver failure resulting in death or transplant per 250,000 - 300,000 patient-years of Serzone treatment ... "

The warning estimates that Serzone-induced liver failure is "about 3-4 times the estimated background rate of liver failure." Patients with active liver disease are advised not to take the drug.

BP Kids

An Italian study of 102 children and adolescents referred to a clinical practice over three years found that 37 had bipolar, 35 had OCD, and 30 had bipolar-OCD. Bipolar II was more frequent in the bipolar-OCD group than in the bipolar group. Kids with pure bipolar had lower rates of panic disorder-agoraphobia than the bipolar-OCD patients and higher rates of ADHD and conduct disorder. Co-occurring OCD did not affect age of onset for the bipolar patients.

Male and Female Brains

The London Daily Mail reports on a Cambridge University survey of 278 males and females which found that one in seven women has a "male" brain and about the same percentage of men have a "female" brain. The participants were given a test that measured how much they empathized with others and their ability to understand and analyze systems. While the women in general scored predictably higher on empathy and the men on systems, 17 percent of the men and 14 percent of the women tested opposite their sex. A third had "balanced brains."

Viagra Doesn’t Get It Done for Women

The NY Times reports that last month Pfizer gave up trying to prove that Viagra could enhance sexual function in women. Although the pill was able to stir arousal in women, it did not always evoke sexual desire. The Times also reports that male arousal is strongly visual, engaging many areas of the brain - particularly the amygdala - that remain relatively quiet in aroused women.

Answer to Quiz

According to a 2000 survey by GayHealth.com, depression ranked as the top health concern among both gays (32 percent) and lesbians (35 percent), ahead of HIV and sexually transmitted disease. Gays and lesbians were two times more likely than heterosexuals to be concerned about depression.

Cracking Down on Cracking Up

NAMI StigmaBusters reports on the latest outrage to the mental health community, "Cracking Up", "a situation comedy that premiered on Fox March 9. A psychology student is invited to live with a Beverly Hills family to treat their young son. The student soon finds the son is fine, but the rest of the family is nuts. In the words of StigmaBusters: "It’s a lot like The Addams Family or The Munsters from the 1960s, except that the stereotypes and butts of jokes involve mental illnesses and substance abuse." You can express your opinion to:

Roland McFarland, Vice President for Broadcast Standards, FOX Broadcasting Company, 10302 West Pico Blvd, Los Angeles CA 90035, Phone: (310) 369-3445.

Mike White, Producer/Writer. "Cracking Up", FOX Broadcasting Company, 10302 West Pico Blvd., Los Angeles, CA 90035, Phone: (310) 369-1000

Jayson Blair

"If I had it [to do] over again, I'd go through it all again so I could get diagnosed." Jayson Blair, who resigned a year ago in disgrace from the NY Times after several of his stories were exposed as fabrications, acknowledging in a Newsday interview that the ordeal led to his diagnosis and treatment for bipolar. He is currently promoting his book, "Burning Down My Master’s House."

Spears’ Latest

Britney Spears’ newest music video was to go like this: Britney retreats into the bathroom following an explosive argument in a hotel room with her date. A hand lays down a glass of red wine, the bathtub overflows, and on the ledge stands a bottle of pills, the cap removed. Britney’s head slips under water. As her date tries to revive her, a new Britney, alive and unharmed, walks past him, out of the room and out of the hotel. Then she disappears past the paparazzi into the night

Apparently the singer had second thoughts about the video. Following a public outcry, her record company issued a statement saying: "Ms. Spears revised the treatment to ensure the video ... will not have a scene in it that could in any way be perceived as a reference to a suicide."

McMan's Web

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John McManamy
"Knowledge is necessity."