While most practitioners, conventional and alternative, focus on fighting heart disease, arthritis and cancer, there is growing concern over the silent epidemic of mental disorders that is becoming one of the most common causes of premature death.
Depression is poorly understood and tolerated in a society that is focused on positivism and a 'can-do' spirit. But it is depression's extreme cousin - bipolar disorder, or manic-depression - that is perhaps the most perplexing of all the mental disorders.
>From 1 to 4.5 per cent of people worldwide will develop bipolar disease during their lifetime. It typically emerges in late adolescence or early adulthood. During manic periods, the sufferer may be overly impulsive and energetic, with an exaggerated sense of self. The depressed phase brings overwhelming feelings of anxiety, low self-worth and suicidal thoughts.
The cyclical nature of the illness means an episode may resolve on its own. Nevertheless, treatment to achieve and maintain a balanced state is important - without it, bipolar disorder can lead to suicide in nearly 20 per cent of cases.
For years, lithium has been the standard solution for this problem. Taken regularly, it can effectively control mania and depression, and reduce the likelihood of a recurrence. The problem is, it's still not known how or why lithium works - or fails - in some cases.
Those who don't respond to lithium or can't tolerate its side-effects, which include weight gain, tremor and excessive urination, are generally prescribed mood stabilisers such as valproate - the only anticonvulsant approved by the US Food and Drug Administration (FDA) for use in bipolar disorder - and carbamazepine.
The brain is a chemical factory that produces neurotransmitters, chemical messengers that help to maintain the body's biochemical balance. To do this job, the brain needs raw materials in the form of amino acids, vitamins, minerals and other nutrients.
Most of us obtain these materials from a well-balanced diet plus daily supplements. But some people have absorption or metabolic disorders severe enough to significantly alter brain function. When this happens, a range of conditions such as bipolar disorder, depression, schizophrenia and attention-deficit disorders can occur.
New treatment approaches
Each of us processes foods in our own way. This is why it is possible for some to thrive on a vegetarian/vegan diet while others need an omnivorous diet to be healthy. Similarly, some individuals seem to get all they need from food alone while others require supplements, sometimes at many times the recommended daily allowance (RDA), to remain healthy.
The complexity of the issue has given rise to what is called 'orthomolecular medicine', a term coined by nutritional pioneer Linus Pauling in 1968 (Science, 1968; 160: 265-71). Since that time, advances in molecular biology and brain chemistry have identified many inherited nutritional imbalances and mechanisms that can lead to mental disorders.
A large percentage of depressed people (Br J Psychiatry, 1970; 117: 287-9) and schizophrenics (Psychiatr Clin Neurosci, 1999; 53: 531-3) is low in folic acid and may be deficient in omega-3 fatty acids (Psychiatr Res, 1999; 85: 275-91; Prostagl Leukotr Essent Fatty Acids, 1996; 55: 3-7). Similarly, individuals with bipolar disorder may have metabolic disturbances that can affect levels of important, mood-regulating neurotransmitters such as serotonin, dopamine, acetylcholine and norepinephrine (noradrenaline).
Among the leaders in this field of study are the practitioners and researchers at the Pfeiffer Treatment Center in Naperville, Illinois, USA. Based on the work of the late Carl Pfeiffer, a professor at Princeton University, the centre is involved in both research and the nutritional treatment of a wide range of mental disorders.
Researchers at the Pfeiffer Center have found that most victims of mental disorders fall into one of three main biochemical classes: low histamine; high histamine; and pyroluric. The Center's scientists have also discovered that excess copper and toxic overload can contribute to certain types of depression (see box above).
Low-histamine, or histapenic, individuals are 'over-methylated'. Around 25 per cent of those with bipolar disorder, and 20 per cent of depressives, 45 per cent of schizophrenics and 15 per cent of those with autism are thought to be histapenic.
Methyls are chemicals consisting of one carbon and three hydrogen atoms. Over-methylated individuals possess too many of these methyls, resulting in excessive levels of the neurotransmitters dopamine, norepinephrine and serotonin. These people are usually nervous and anxious, and prone to paranoia and despair. Generally free of seasonal allergies, they often report a multitude of food and chemical sensitivities. They may also have a history of underachievement, hyperactivity and learning disability.
In contrast, high-histamine, or histadelic, depressives overproduce and retain excess levels of histamine, an important neurotransmitter that affects human behaviour. They are said to be 'under-methylated', with low levels of serotonin, dopamine and norepinephrine. They represent 35 per cent of all cases of bipolar disorders, half of all depressives, 18 per cent of schizophrenics, 45 per cent of those with autism and nearly all of those with obsessive-compulsive disorder and anorexia/bulimia.
Symptoms in these patients can include seasonal variations in depression, obsessive-compulsive tendencies, inhalant allergies and frequent headaches as well as perfectionism, high libido and sparse body hair. Such individuals may appear outwardly calm, but suffer from extreme internal anxiety.
About 20 per cent of those labelled bipolar have a genetic pyrrole disorder. This is associated with high kryptopyrrole production as well as fatty-acid abnormalities - especially depressed arachidonic acid - very poor immune function and severe metal-oxidative stress. Rapid-cycle patients - those who experience more than four manic-depressive episodes a year - are often affected by pronounced pyrrole disorder. Around 18 per cent of those with bipolar disorder, 20 per cent of depressed individuals, 27 per cent of schizophrenics and 20 per cent of autistic people have this disorder, compared with 10 per cent of the general population.
Pyrolurics are devastated by stress such as physical injury, emotional trauma, illness and sleep deprivation. These individuals often report an inability to eat breakfast, sensitivity to light and noises, reading disorders, hysteria, rage, severe anxiety, absence of dream recall and frequent infections.
These categories, of course, are general and some crossover among them is inevitable. For instance, a person can be histadelic, but suffer from the same types of imbalances seen in pyroluria as well.
The Pfeiffer Center programme involves asking a basic question that few other practitioners ask: who is the patient nutritionally? Finding the answer involves extensive chemical analysis of blood, urine and tissues to define the patient's biochemistry. Treatment requires supplements of specific vitamins, minerals and amino acids (see box above) that need to be supplied with rifle-shot precision - and sometimes in very high doses.
Research into the biochemical treatment of bipolar disorder is not as prolific as it is for disorders such as depression and schizophrenia. Nevertheless, what there is gives cause for optimism.
Depressed people may have an impaired ability to metabolise certain essential fatty acids (Prostagl Leukotr Essent Fatty Acids, 1999; 60: 217-34), leading to lower blood levels of omega-3s (Lipids, 1996; 31 Suppl: S157-61; Psychiatr Res, 1999; 85: 275-91). For these individuals, the typical Western diet, which greatly favours omega-6 fatty acids, may be disastrous. Conventional medication may also worsen the problem (Eur Neuropsychopharmacol, 2003; 13: 99-103).
One double-blind trial discovered that people taking 9.6 g/day of omega-3s from fish oil in addition to their conventional medications had significantly improved bipolar symptoms compared with those taking a placebo (Arch Gen Psychiatry, 1999; 56: 407-12).
Both folic acid and vitamin B12 are used in the body to make serotonin and other neurotransmitters. A deficiency of either nutrient is associated with depression (Nutr Rev, 1996; 54: 382-90; South Med J, 1991; 84: 1475-81). Those diagnosed with mania also tend to have folate deficiencies (J Affect Disord, 1997; 46: 95-9), though some studies dispute this (Acta Psychiatr Scand, 1991; 83: 199- 201; J Affect Disord, 1992; 24: 265-70). There is evidence that increasing levels of folate can improve the response rate to lithium (J Affect Disord, 1986; 10: 9-13) but, again, there are also other data that dispute this claim (Int Clin Psychopharmacol, 1988; 3: 49-52).
On their own, both mania and depression are associated with vitamin-B12 deficiency, and injections of B12 can help clear these symptoms (Am J Psychiatry, 1984; 141: 300-1; J Clin Psychiatry, 1991; 52: 182-3). Although B12 deficiency is poorly researched in bipolar disorder, case reports suggest it may be a factor (West Ind Med J, 2000; 49: 347-8).
A double-blind trial found that, compared with a placebo, both manic and depressed bipolar patients significantly improved after a one-time-only administration of 3 g of vitamin C (Psychol Med, 1981; 11: 249-56). Vitamin C helps the body reduce its load of vanadium (Nutr Health, 1984; 3: 79-85), an excess of which may cause bipolar disorder, and 4 g/day combined with the chelator EDTA (which removes elements such as vanadium from the body) helped depressed bipolar patients, but not those with mania (Psychol Med, 1984; 14: 533-9).
The amino-acid L-tryptophan can improve depression (Fortschr Med, 1998; 116: 40-2), and high doses (9.6 g/day) may help bipolar patients with acute mania (Psychopharmacologia, 1974; 34: 11-20). Those taking lithium or an antidepressant markedly improved when L-tryptophan at 12 g/day was added to their treatment (Am J Psychiatry, 1979; 136: 719-20; J Clin Psychopharmacol, 1984; 4: 347-8).
Supplemental 5-HTP (a serotonin precursor) at 200 mg/day had antidepressant effects in bipolar patients, although it was not as effective as lithium (Acta Psychiatr Scand Suppl, 1981; 290: 191-201). 5-HTP may also enhance the effectiveness of antidepressants (J Affect Disord, 1980; 2: 137-46).
Yet another amino acid, S-adenosylmethionine (SAMe), has been proved in clinical trials to have significant antidepressant effects in bipolar patients (Acta Psychiatr Scand, 1990; 81: 432-6; Drugs, 1989; 38: 389-417).
However, in common with conventional antidepressants, some patients have swung from depression to mania with SAMe at 500-1600 mg/day (Br J Psychiatry, 1989; 154: 48-51). This mania can resolve spontaneously with continued supplementation (Acta Psychiatr Scand, 1990; 81: 432-6), but those with bipolar disorder should probably take SAMe only under the guidance of a qualified practitioner.
Inositol may be reduced in depressed and bipolar patients (Am J Psychiatry, 1997; 154: 1148-50), and can have significant antidepressant effects at a high dose of 12 g/day (Am J Psychiatry, 1995; 152: 792-4; Isr J Psychiatry Relat Sci, 1995; 32: 14-21). However, some bipolar patients have reported either little benefit (Br J Psychiatry, 1994; 164: 133-4) or a worsening of their symptoms (Am J Psychiatry, 1996; 153: 839).
Orthomolecular treatment can take weeks before a change in symptoms becomes evident - or it may not work at all. It is said to be most effective in those who have significant biochemical imbalances, but such patients may also have the most severe symptoms and may be resistant to the more aggressive forms of conventional care. For these individuals, using nutrition to balance glitches in their genetic make-up may help, at the very least, to reduce dependence on medication and, as such, can be considered a positive step on the road to good mental health.