Welcome to another edition of Common Ground Online. Here's what's in this week's edition:
- Nutritional Aspects of Child and Adolescent Psychopharmacology
- Vitamin/Mineral Facts
- Multi-ingredient Supplementation
- Drug-Nutrient Interactions
In a recent peer reviewed publication in the Psychiatric Annals, Dr. Bonnie J. Kaplan and Dr. Scott Shannon wrote a compelling article on the importance of
child and adolescent psychiatric patients
being adequately supplemented with vitamins and minerals. They explore the "fundamentals of nutrition and brain biochemistry shown to be important in psychiatric disorders, including the potential therapeutic benefit of nutrient supplementation." In doing this, they outline how "vitamins, minerals, amino acids, and essential fatty acids...are the building blocks of neuronal structure and function, and...can be expected to influence brain function..."
Additionally, they discuss "what is known of drug-nutrient interactions, including nutrient stress introduced by drugs that interfere with metabolism and increase the requirement for specific nutrients." In their article, they use EMPowerplus as a key example of how proper supplementation can be an effective means of addressing even very serious psychiatric diagnoses.
The following are key points from this article:
Vitamin/Mineral Facts:
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"A review of modern neuropharmacology reveals that micronutrients (vitamins and minerals) function as cofactors in almost every aspect of neurotransmitter synthesis. [Dr. Bruce] Ames has suggested that suboptimal micronutrient levels result in slowed metabolic reactions and reported about 50 genetically influenced errors reversible by providing high levels of micronutrients."
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"Both the symptoms of depression and poor response to antidepressant medication have been found to be associated with low levels of folic acid."
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"Thiamine (vitamin B1) is important for the synthesis of acetylcholine, relevant to both depression and dementia. In a 2-month randomized controlled trial (RCT) with 120 women college students not suffering from diagnosed mental disorders, placebo was compared with those taking 50 mg thiamine daily. Improved mood in those who received the thiamine was documented with weekly self reported scores on the Profile of Mood States, especially in those who began the treatment with low thiamine status."
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"Biotin, generally thought to be in the class of B vitamins, has been studied more recently: biotin deficiency can cause withdrawn behavior, a delay in cognitive development or hallucinations."
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"It is now known that zinc plays a role in more than 100 metabolic pathways in the brain."
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"Zinc is the second most abundant transition metal in the brain next to iron and plays a role in synaptic transmission, DNA synthesis, and the function of many enzymes."
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"Examining copper/zinc ratios in 135 assaultive, incarcerated males in comparison with controls, Walsh and colleagues found a linear relationship between the degree of zinc deficiency and the seriousness of the behavior, ranging from verbal assault to aggravated and violent assault. The zinc results in humans are consistent with a large, older literature on lab animals, which demonstrates that zinc deficiency is associated with impaired learning and memory; immunodeficiency, and delayed motor development."
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"Calcium imbalance caused by hyperparathyroidism affects anxiety, depression, and cognitive function. Some reports indicate that intracellular calcium signaling systems play a role in the pathophysiology of bipolar disorder."
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"Magnesium plays a role in neurotransmitter release as well as post-synaptic receptor function and has a depressant effect at synapses, inhibiting the release of neurotransmitters such as acetylcholine, and antagonizing receptors such as the NMDA receptor."
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"The brain contains a number of iron dependent enzymes that are necessary for the synthesis, function, and degradation of neurotransmitters as well as other cellular processes. Low levels of serum iron have been found in people with major depression, and women with low postpartum hemoglobin levels had higher depression scores at 28 days postpartum."
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"Selenium is believed to play an important role in brain function, suspected from its selective retention by the brain in times of deficiency. A 5-week RCT involving 50 healthy participants indicated that selenium improved mood scores and decreased anxiety as compared with placebo."
Multi-ingredient Supplementation:
"Five different open reports have suggested that a broad spectrum multivitamin/ mineral formula called Empowerplus deserves further study as a potential treatment for unstable mood symptoms in both children and adults. In an ABAB reversal design, on-off control of mood and temper symptoms were demonstrated in two children, who were then followed for more than 4 years. Two open label case series, one in children with mood and anxiety disorders and another in adults with bipolar disorder provided positive results with large effect sizes. These results have been replicated in cases series in clinical settings by two independent psychiatrists using the same nutrient supplement. Children and adolescents were included in both these replications."
Drug-Nutrient Interactions:
"On one hand, we have mounting evidence that key nutrients can play a significant role in psychiatric illness and their treatment. On the other hand, we have the extremely common clinical observation that psychiatric medications alter nutritional status in children by changing appetite, food selection, and weight. Appetite suppression may induce parents to allow a switch from micronutrient-rich foods to the “empty calories” found in sugar and fat in order to maintain weight. There is significant research that indicates that many psychiatric medications shift the metabolism of key nutrients. Conversely, nutrients can create alterations in the bioavailability of psychiatric medications. This complex biochemistry comes into clinical psychiatric relevance in the child’s brain."
"Psychiatric medications may significantly alter many other factors that influence the status of the child’s neurochemistry such as absorption and excretion of key nutrients. A large number of child and adolescent psychiatry patients exhibit many characteristics of being at high risk for drug-nutrient interactions: ongoing growth, high levels of stress, two or more medications at once, taking medications over extended periods of time, smoking or drinking alcohol, making poor dietary choices, experiencing medication-induced appetite, and weight change. Ultimately, the psychiatric medication alters the bioavailability of the selected nutrient."
Conclusion:
"Recent JAMA articles recommended vitamin supplementation for the general adult population as deficiencies were found to be common and a risk factor for chronic illness. In a growing child with risk factors for psychiatric illness, the importance of supplementation would likely be magnified, given the escalation of nutrient demands found in the stressed or symptomatic child. Thus it seems reasonable to recommend vitamin/mineral supplementation at RDA/RNI (reference nutrient intake) levels for all child and adolescent psychiatric patients. The risk benefit ratio is low, and the potential prevention of psychiatric illness is significant."
Click on the citation to access the full article.
Kaplan BJ, Shannon S. Nutritional aspects of child and adolescent psychopharmacology, Psychiatric Annals. 2007 July; 37(7): 519-28.
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