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Orthomolecular psychiatry is the use of orthomolecular medicine for mental illness. The approach uses unorthodox forms of individualized testing and diagnosis to attempt to establish an etiology for each patient's specific symptoms, and claims to tailor the treatment accordingly, using a combination of nutrients, dietary changes and medications that are claimed to enhance quality of life and functionality as well as to reduce or eliminate symptoms and the use of xenobiotic drugs. Orthomolecular psychiatry has been rejected by the mainstream medical community.
Orthomolecular psychiatry began with Abram Hoffer and Humphry Osmond in the 1950s and was continued by Carl Pfeiffer of the Pfeiffer Treatment Center, although proponents of orthomolecular psychiatry say that the ideas behind their approach can be traced back to the 1920s and '30s. Orthomolecular psychiatry's goal of weaning patients from conventional neuroleptic drugs follows "Pfeiffer's Law", "For every drug that benefits a patient, there is a natural substance that can achieve the same effect". In 1968, Linus Pauling used the term "orthomolecular".
Abram Hoffer in the 1950s was the first major practitioner. Hoffer's therapies focused on using niacin, among other nutrients, to treat what he diagnosed as acute schizophrenia based on an unaccepted test. In 1973, a task force of the American Psychiatric Association examined niacin monotherapy of patient populations with chronic schizophrenia and bipolar disorder and rejected the practice along with the reliability of Hoffer's diagnostic approach.
The assertions by proponents of orthomolecular psychiatry were rejected in 1973 by a panel of the American Psychiatric Association. Orthomolecular psychiatry has subsequently resurged in the last ten years, however, and has found growing footing in adjunctive medical circles with the rise in conditions such as autism, heavy metal toxicity, and chronic inflammatory disease. After 1975, orthomolecular psychiatry research was primarily reported in Orthomolecular Psychiatry, now the Journal of Orthomolecular Medicine, a publication founded by Abram Hoffer to counter what he considered to be a medical conspiracy against his ideas.
It could be said that Orthomolecular psychiatry has failed to gain acceptance from mainstream medicine because it had few successful clinical trial's to back up the approach nor has it a unifying theory. In the last five years significant research has been completed and published.
Two proponents have been the forefront in recent years . These are William J. Walsh Phd and Dr Ben Lynch. William J. Walsh Phd, from "The Walsh Research Institute" has now published many scientific articles. Altered vascular phenotype in autism: correlation with oxidative stress, Reduced violent behavior following biochemical therapy, Fatty acid profiles of schizophrenic phenotypes, Causes of Debilitating Anxiety, Approprtate Lab Tests and Treatment Options, plus many more.
In a just released article in the American Journal of Psychiatry, A large proportion of patients with severe, refractory depression have metabolic disorders that, once treated, appear to alleviate depressive symptoms over the long term. "Our findings, if replicated, suggest that neurometabolic disorders may contribute to treatment-refractory psychiatric disorders even without other systemic illness," the authors, led by Lisa A. Pan, MD, University of Pittsburgh School of Medicine in Pennsylvania, write. Metabolic Disorders Linked to Severe, Refractory Depression by Nancy A. Melville.
While not specifically Orthomolecular psychiatry because no individual testing is done, Professor Julia Rucklidge from the University of Christchurch, has also published a number peer reviewed scholarly articles. These clinical trials relate to "high dosing" people with many times the daily recommended dose of nutrients and vitamins. Clinically Significant Symptom Reduction in Children with Attention-Deficit/Hyperactivity Disorder Treated with Micronutrients: An Open-Label Reversal Design Study, Broad-spectrum micronutrient formulas for the treatment of psychiatric symptoms: a systematic review, Nutritional medicine as mainstream in psychiatry, Vitamin-mineral treatment of attention-deficit hyperactivity disorder in adults: double-blind randomised placebo-controlled trial, The Emerging Field of Nutritional Mental Health Inflammation, the Microbiome, Oxidative Stress, and Mitochondrial Function, and Psychological functioning 1 year after a brief intervention using micronutrients to treat stress and anxiety related to the 2011 Christchurch earthquakes, The most famous piece by Professor Rucklidge is the viral YouTube video "The surprisingly dramatic role of nutrition in mental health | Julia Rucklidge | TEDxChristchurch" that by May 2017 had over 550,000 views. In another video, Rucklidge made the now famous statement "what have you got to lose" people are not getting
Proponents of orthomolecular psychiatry claim to have identified the causes of some psychiatric syndromes, in particular those that cause psychosis; according to orthomolecular proponents, testing for these causes guides diagnosis and treatment. Diagnostic measures and therapies commonly employed include "individual biochemical workup", fasting, identifying suggested allergies, dietary changes, megavitamin therapy, amino acids, and other so-called "pharmacologic nutrients". These diagnoses have not been accepted by mainstream medicine.
Neurological Disorders "Defects in vitamin B6 metabolism may contribute to some types of neurological abnormalities, because of the involvement of PLP in numerous key pathways of neural functions (namely neurotransmitter synthesis, amino acid metabolism, sphingolipid biosynthesis, and degradation).".
Orthomolecularists claim that the causes of psychotic disorders include food allergy, hypoglycemia, hypothyroidism in the presence of normal thyroid values, heavy metal intoxications including those allegedly due to dental fillings, as well as several hypothesised conditions they call pyroluria, histadelia and histapenia. These conditions are said to be not recognized by the conventional medical community though over 400 medical practitioners have now attended the Walsh Research Institute practitioner education workshops world wide.
Pyroluria (or malvaria from the term mauve factor) involves hypothetical excessive levels of pyrroles in the body resulting from improper hemoglobin synthesis. Carl Pfeiffer believed that pyroluria is a form of schizophrenic porphyria, similar to acute intermittent porphyria where both pyrroles and porphyrins are excreted in the human urine to an excessive degree. and orthomolecular psychiatrists have alleged that pyroluria is related to diagnoses of ADHD, alcoholism, autism, depression, down syndrome, manic-depression, schizophrenia, celiac disease, epilepsy, and psychosis. Pfeiffer's methods have not been rigorously tested, and pyrroles are not considered to be related to schizophrenia. Studies have either failed to detect hemopyrrole and kryptopyrrole in the urine of normal controls and schizophrenics, or found no correlation between these chemicals and mental illness. Few, if any, medical experts regard the condition as genuine, and few or no articles on pyroluria are found in modern medical literature; the approach is described as "snake oil" by pediatrician and author Julian Haber.
Histadelia is a condition hypothesised by Carl Pfeiffer to involve elevated serum levels of histamine and basophils, which he says can be treated with methionine and vitamin B6 megadoses. Pfeiffer claims that "histadelia" can cause depression with or without psychosis, but no published clinical trials have tested the effectiveness of this therapy.
Histapenia in orthomolecular medicine is the condition of high serum copper with low histamine.
Relationship to mainstream psychiatry
Orthomolecular psychiatry has been rejected by the mainstream medical community. Critics have noted that the claims advanced by its proponents are unsubstantiated, and even false. Authoritative bodies such as the National Institute of Mental Health and American Academy of Pediatrics have criticized orthomolecular treatments as ineffective and toxic.
A 1973 task force of the American Psychiatric Association charged with investigating orthomolecular claims 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.
One review suggested the APA statement was "well-intentioned" but biased, and called for further research in this field.
- Saul, AW; Jolliffe M; Hoffer A. "Bibliography of the Publications of Carl Pfeiffer, MD, PhD". doctoryourself.com. Retrieved 2007-04-19.
- Reiter, PJ (1927). "Behandlung von Dementia Praecox mit metallsalzen. Mangan. Z". Neur. 108: 464–80. doi:10.1007/bf02863975. as cited in Pfeiffer, C; LaMola, S (1983). "Zinc and Manganese in the Schizophrenias". Journal of Orthomolecular Psychiatry. 12 (3).
- Kay Lily E (1993). The molecular vision of life: Caltech, the Rockefeller Foundation, and the rise of the new biology. Oxford: Oxford University Press. ISBN 0-19-511143-5.
- Edelman Eva (2001). Natural Healing for Schizophrenia: And Other Common Mental Disorders. Borage Books. ISBN 0-9650976-7-6.
- Barney, Paul (1998). Doctor's guide to natural medicine. Pleasant Grove, Utah: Woodland. ISBN 1-885670-84-2.
- Pauling L (1968). "Orthomolecular psychiatry. Varying the concentrations of substances normally present in the human body may control mental disease" (PDF). Science. 160 (3825): 265–71. Bibcode:1968Sci...160..265P. doi:10.1126/science.160.3825.265. PMID 5641253.
- Pauling, Linus; Hawkins, D (1973). Orthomolecular psychiatry: treatment of schizophrenia. San Francisco: W.H. Freeman. p. 697. ISBN 0-7167-0898-1.
- Menolascino FJ, Donaldson JY, Gallagher TF, Golden CJ, Wilson JE (1988). "Orthomolecular therapy: its history and applicability to psychiatric disorders". Child Psychiatry Hum Dev. 18 (3): 133–50. doi:10.1007/BF00709727. PMID 2898324.
- Pauling L, Wyatt RJ, Klein DF, Lipton MA (1974). "On the orthomolecular environment of the mind: orthomolecular theory". American Journal of Psychiatry. 131 (11): 1251–67. doi:10.1176/ajp.131.11.1251. PMID 4608217.
- Lerner, V (2005-08-31). "Treatment of acute schizophrenia with vitamin therapy". Clinicaltrials.gov. Retrieved 2008-01-15.
- Hoffer, Abram. "The History of the Journal of Orthomolecular Medicine". J Orthomol Med.
- Yao, Yuemang; Walsh, William J.; McGinnis, Woody R.; Praticò, Domenico (2006-08-01). "Altered Vascular Phenotype in Autism". Archives of Neurology. 63 (8): 1161. doi:10.1001/archneur.63.8.1161. ISSN 0003-9942.
- Walsh, William J.; Glab, Laura B.; Haakenson, Mary L. (2004-10-15). "Reduced violent behavior following biochemical therapy". Physiology & Behavior. 82 (5): 835–839. doi:10.1016/j.physbeh.2004.06.023.
- Pan, Lisa A.; Martin, Petra; Zimmer, Thomas; Segreti, Anna Maria; Kassiff, Sivan; McKain, Brian W.; Baca, Cynthia A.; Rengasamy, Manivel; Hyland, Keith (2016-08-13). "Neurometabolic Disorders: Potentially Treatable Abnormalities in Patients With Treatment-Refractory Depression and Suicidal Behavior". American Journal of Psychiatry. 174 (1): 42–50. doi:10.1176/appi.ajp.2016.15111500. ISSN 0002-953X.
- Gordon, Heather A; Rucklidge, Julia J; Blampied, Neville M; Johnstone, Jeanette M (2015-12-01). "Clinically Significant Symptom Reduction in Children with Attention-Deficit/Hyperactivity Disorder Treated with Micronutrients: An Open-Label Reversal Design Study". Journal of Child and Adolescent Psychopharmacology. 25 (10): 783–798. doi:10.1089/cap.2015.0105. ISSN 1044-5463. PMC . PMID 26682999.
- Rucklidge, Julia J.; Kaplan, Bonnie J. (2013-01-01). "Broad-spectrum micronutrient formulas for the treatment of psychiatric symptoms: a systematic review". Expert Review of Neurotherapeutics. 13 (1): 49–73. doi:10.1586/ern.12.143. ISSN 1473-7175. PMID 23253391.
- Julia, Rucklidge (March 2015). "Nutritional medicine as mainstream in psychiatry". The Lancet Psychiatry.
- Rucklidge, Julia J.; Frampton, Chris M.; Gorman, Brigette; Boggis, Anna (2014-04-01). "Vitamin-mineral treatment of attention-deficit hyperactivity disorder in adults: double-blind randomised placebo-controlled trial". The British Journal of Psychiatry. 204 (4): 306–315. doi:10.1192/bjp.bp.113.132126. ISSN 0007-1250. PMID 24482441.
- Julia, Rucklidge (February 2, 2015). "The Emerging Field of Nutritional Mental Health". Clinical Psychological Science. Clinical Psychological Science - Sage Science. 3: 964–980. doi:10.1177/2167702614555413.
- Rucklidge, Julia J.; Blampied, Neville; Gorman, Brigette; Gordon, Heather A.; Sole, Ellen (2014-05-01). "Psychological functioning 1 year after a brief intervention using micronutrients to treat stress and anxiety related to the 2011 Christchurch earthquakes: a naturalistic follow-up". Human Psychopharmacology: Clinical and Experimental. 29 (3): 230–243. doi:10.1002/hup.2392. ISSN 1099-1077.
- Barrett MD, Stephen (2000-07-12). "Orthomolecular Therapy". Quackwatch. Retrieved 2008-01-02.
- Alfred H. Merrill, Jr.; Michael Henderson (1987). Diseases Associated with Defects in Vitamin B6 Metabolism or Utilization. Annual Reviews.
- Laperchia, P. (1987). "Behavioral disorders, learning disabilities and megavitamin therapy". Adolescence. 22 (87): 729–738. PMID 2963502.
- "Pyroluria". nutritional-healing.com. Retrieved 2008-02-17.
- Jackson James A; Riordan Hugh D; Neathery Sharon; Riordan Neil H (1997). "Urinary pyrrole in health and disease" (PDF). The Journal of Orthomolecular Medicine. 12 (2nd Quarter): 96–8. Retrieved 2008-02-17.
- Skertic, Mark (April 21, 2002). "For some, a question of balancing nutrients". SunTimes.com. Available at the internet archive. Retrieved on 2008-02-17
- Holman, Paul (July 1995). "Pyridoxine - Vitamin B-6" (PDF). Journal of Australian College of Nutritional & Environmental Medicine. 14 (1): 5–16. Archived from the original (PDF) on 2007-05-08. Retrieved 2007-04-19.
- Cruz, R; Vogel, WH (1978). "Pyroluria: a poor marker in chronic schizophrenia". The American Journal of Psychiatry. 135 (10): 1239–40. PMID 696910.
- Gendler, PL; Duhan, HA; Rapoport, H (1978). "Hemopyrrole and kryptopyrrole are absent from the urine of schizophrenics and normal persons". Clinical Chemistry. 24 (2): 230–3. PMID 627053.
- Jacobson, SJ; Rapoport, H; Ellman, GL (1975). "The nonoccurrence of hemo- and kryptopyrrole in urine of schizophrenics". Biological Psychiatry. 10 (1): 91–3. PMID 1120177.
- Gorchein, A (1980). "Urine concentration of 3-ethyl-5-hydroxy-4,5-dimethyl-delta 3-pyrrolin-2-one ('mauve factor') is not causally related to schizophrenia or to acute intermittent porphyria". Clinical Science. 58 (6): 469–76. PMID 7428279.
- Vaughan, K.; McConaghy, N. (1999). "Megavitamin and dietary treatment in schizophrenia: a randomised, controlled trial". The Australian and New Zealand Journal of Psychiatry. 33 (1): 84–88. doi:10.1046/j.1440-1614.1999.00527.x. PMID 10197889.
- National Library for Health (2005-10-05). "What is pyroluria, is it an accepted clinical entity and what are the treatment?". Archived from the original on 2007-02-11.
- Pfeiffer Carl C, et al. (July 1971). "Blood histamine levels, basophil counts, and trace metals in the schizophrenias". Psychopharmacol Bull. 7 (3): 37. PMID 5117854.
- Pfeiffer Carl C; Smyrl, EG; Iliev, V (July 1972). "Extreme basophil counts and blood histamine levels in schizophrenic outpatients as compared to normals". Res Commun Chem Pathol Pharmacol. 4 (1): 51–9. PMID 4671910.
- Pfeiffer Carl C (1988). Nutrition and Mental Illness: An Orthomolecular Approach to Balancing Body Chemistry. Healing Arts Press. ISBN 0-89281-226-5.
- Pfeiffer, Carl C (1987). Nutrition and Mental Illness: An Orthomolecular Approach to Balancing Body Chemistry. Healing Art Press. ISBN 0-89281-226-5.
- Miller M (1996). "Diet and psychological health". Altern Ther Health Med. 2 (5): 40–8. PMID 8795935.
- Bennett, Forrest C. "Vitamin and mineral supplementation in Down's syndrome".
- Lipton M, et al. (1973). Task force report on megavitamin and orthomolecular Therapy in psychiatry. Washington DC: American Psychiatric Association.; as cited in Barrett MD, Stephen (2000-07-12). "Orthomolecular Therapy". Quackwatch. Retrieved 2008-01-02.
- Hoffer, L. J. (2008). "Vitamin therapy in schizophrenia". The Israel Journal of Psychiatry and Related Sciences. 45 (1): 3–10. PMID 18587164.
- Braverman, Eric R; Pfeiffer, Carl Curt; Blum, Kenneth; Smayda, Richard (2003). The healing nutrients within: facts, findings, and new research on amino acids (3rd ed.). North Bergen, New Jersey: Basic Health. ISBN 1-59120-037-7.
- Pauling, Linus; Hawkins, D. (1973). Orthomolecular psychiatry: treatment of schizophrenia. San Francisco: W.H. Freeman. p. 697. ISBN 0-7167-0898-1.
- Pfeiffer, Carl J (1987). Nutrition and mental illness: An orthomolecular approach to balancing body chemistry. Healing Arts. ISBN 0-89281-226-5.
- Werbach, Melvyn R (1999). Nutritional influences on mental illness: a sourcebook of clinical research. Tarzana, California: Third Line. ISBN 0-9618550-8-8.