Orthomolecular psychiatry is the use of

orthomolecular medicine Orthomolecular medicine is a form of alternative medicine that claims to maintain human health through nutritional Dietary supplement, supplementation. It is rejected by evidence-based medicine. The concept builds on the idea of an optimal nutrit ...

for

mental illness A mental disorder, also referred to as a mental illness, a mental health condition, or a psychiatric disability, is a behavioral or mental pattern that causes significant distress or impairment of personal functioning. A mental disorder is ...

. Orthomolecular psychiatry has been rejected by evidence-based medicine and has been called

quackery Quackery, often synonymous with health fraud, is the promotion of fraudulent or Ignorance, ignorant medicine, medical practices. A quack is a "fraudulent or ignorant pretender to medical skill" or "a person who pretends, professionally or public ...

. The approach uses unorthodox forms of individualized testing and diagnosis to attempt to establish an

etiology Etiology (; alternatively spelled aetiology or ætiology) is the study of causation or origination. The word is derived from the Greek word ''()'', meaning "giving a reason for" (). More completely, etiology is the study of the causes, origins ...

for each patient's specific

symptom Signs and symptoms are diagnostic indications of an illness, injury, or condition. Signs are objective and externally observable; symptoms are a person's reported subjective experiences. A sign for example may be a higher or lower temperature ...

s, and claims to tailor the treatment accordingly, using a combination of nutrients, dietary changes and

medication Medication (also called medicament, medicine, pharmaceutical drug, medicinal product, medicinal drug or simply drug) is a drug used to medical diagnosis, diagnose, cure, treat, or preventive medicine, prevent disease. Drug therapy (pharmaco ...

s that are claimed to enhance quality of life and functionality as well as to reduce or eliminate symptoms and the use of

xenobiotic A xenobiotic is a chemical substance found within an organism that is not naturally produced or expected to be present within the organism. It can also cover substances that are present in much higher concentrations than are usual. Natural compo ...

drugs. Scientific studies have shown mixed results; although there are some promising results from nutritional psychiatry, some forms of orthomolecular psychiatry are ineffective.

History

Orthomolecular psychiatry began with Abram Hoffer and

Humphry Osmond Humphry Fortescue Osmond (1 July 1917 – 6 February 2004) was an English psychiatrist who moved to Canada and later the United States. He is known for inventing the word '' psychedelic'' and for his research into interesting and useful applicat ...

in the 1950s and was continued by Carl Pfeiffer, 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 Linus Carl Pauling ( ; February 28, 1901August 19, 1994) was an American chemist and peace activist. He published more than 1,200 papers and books, of which about 850 dealt with scientific topics. ''New Scientist'' called him one of the 20 gre ...

first used the term ''orthomolecular''. Hoffer's therapies focused on using

niacin Nicotinic acid, or niacin, is an organic compound and a vitamer of vitamin B3, an essential human nutrient. It is produced by plants and animals from the amino acid tryptophan. Nicotinic acid is also a prescription medication. Amounts f ...

, among other nutrients, to treat what he diagnosed as acute

schizophrenia Schizophrenia () is a mental disorder characterized variously by hallucinations (typically, Auditory hallucination#Schizophrenia, hearing voices), delusions, thought disorder, disorganized thinking and behavior, and Reduced affect display, f ...

based on an unaccepted test. In 1973, a task force of the

American Psychiatric Association The American Psychiatric Association (APA) is the main professional organization of psychiatrists and trainee psychiatrists in the United States, and the largest psychiatric organization in the world. It has more than 39,200 members who are in ...

examined niacin monotherapy of patient populations with chronic schizophrenia and

bipolar disorder Bipolar disorder (BD), previously known as manic depression, is a mental disorder characterized by periods of Depression (mood), depression and periods of abnormally elevated Mood (psychology), mood that each last from days to weeks, and in ...

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

. However, the underpinning ideas of orthomolecular psychiatry have become popular in alternative medical circles as a means to explain conditions such as

autism Autism, also known as autism spectrum disorder (ASD), is a neurodevelopmental disorder characterized by differences or difficulties in social communication and interaction, a preference for predictability and routine, sensory processing d ...

, heavy metal toxicity, and chronic inflammatory disease. After 1975, orthomolecular psychiatry research was primarily reported in ''Orthomolecular Psychiatry'', now the ''

Journal of Orthomolecular Medicine The ''Journal of Orthomolecular Medicine'' was established in 1967 by Abram Hoffer. It publishes studies in nutritional and orthomolecular medicine Orthomolecular medicine is a form of alternative medicine that claims to maintain human health t ...

'', a publication founded by Hoffer to counter what he considered to be a medical conspiracy against his ideas.

Diagnosis

Proponents of orthomolecular psychiatry claim to have identified the causes of some psychiatric syndromes, in particular those that cause

psychosis In psychopathology, psychosis is a condition in which a person is unable to distinguish, in their experience of life, between what is and is not real. Examples of psychotic symptoms are delusions, hallucinations, and disorganized or inco ...

; according to orthomolecular proponents, testing for these causes guides diagnosis and treatment. Diagnostic measures and therapies commonly employed include "individual biochemical workup",

fasting Fasting is the act of refraining from eating, and sometimes drinking. However, from a purely physiological context, "fasting" may refer to the metabolic status of a person who has not eaten overnight (before "breakfast"), or to the metabolic sta ...

, identifying suggested

allergies Allergies, also known as allergic diseases, are various conditions caused by hypersensitivity of the immune system to typically harmless substances in the environment. These diseases include Allergic rhinitis, hay fever, Food allergy, food al ...

, dietary changes,

megavitamin therapy Megavitamin therapy is the use of large doses of vitamins, often many times greater than the recommended dietary allowance (RDA) in the attempt to prevent or treat diseases. Megavitamin therapy is typically used in alternative medicine by pract ...

amino acid Amino acids are organic compounds that contain both amino and carboxylic acid functional groups. Although over 500 amino acids exist in nature, by far the most important are the 22 α-amino acids incorporated into proteins. Only these 22 a ...

s, and other so-called "pharmacologic nutrients". These diagnoses have not been accepted by mainstream medicine.

Specific conditions

Orthomolecularists claim that the causes of psychotic disorders include

food allergy A food allergy is an abnormal immune system, immune response to food. The symptoms of the allergic reaction may range from mild to severe. They may include pruritus, itchiness, swelling of the tongue, vomiting, diarrhea, hives, trouble breathi ...

hypoglycemia Hypoglycemia (American English), also spelled hypoglycaemia or hypoglycæmia (British English), sometimes called low blood sugar, is a fall in blood sugar to levels below normal, typically below 70 mg/dL (3.9 mmol/L). Whipple's tria ...

hypothyroidism Hypothyroidism is an endocrine disease in which the thyroid gland does not produce enough thyroid hormones. It can cause a number of symptoms, such as cold intolerance, poor ability to tolerate cold, fatigue, extreme fatigue, muscle aches, co ...

in the presence of normal thyroid values, heavy metal intoxications including those allegedly due to

dental fillings Dental restoration, dental fillings, or simply fillings are treatments used to restore the function, integrity, and morphology of missing tooth structure resulting from caries or external trauma as well as the replacement of such structure suppor ...

, as well as several hypothesised conditions they call ''pyroluria'', ''histadelia'' and ''histapenia''.

Pyroluria

''Pyroluria'' (or ''malvaria'' from the term ''mauve factor'') involves hypothetical excessive levels of

pyrrole Pyrrole is a heterocyclic, aromatic, organic compound, a five-membered ring with the formula . It is a colorless volatile liquid that darkens readily upon exposure to air. Substituted derivatives are also called pyrroles, e.g., ''N''-methylpyrrol ...

s in the body resulting from improper hemoglobin synthesis. Carl Pfeiffer believed that pyroluria is a form of

schizophrenic Schizophrenia () is a mental disorder characterized variously by hallucinations (typically, Auditory hallucination#Schizophrenia, hearing voices), delusions, thought disorder, disorganized thinking and behavior, and Reduced affect display, f ...

porphyria Porphyria ( or ) is a group of disorders in which substances called porphyrins build up in the body, adversely affecting the skin or nervous system. The types that affect the nervous system are also known as Porphyria#Acute porphyrias, acute p ...

, similar to

acute intermittent porphyria Acute intermittent porphyria (AIP) is a rare Metabolism, metabolic disorder affecting the production of heme resulting from a deficiency of the enzyme porphobilinogen deaminase. It is the most common of the acute porphyrias. Signs and symptoms Th ...

where both

s and

porphyrin Porphyrins ( ) are heterocyclic, macrocyclic, organic compounds, composed of four modified pyrrole subunits interconnected at their α carbon atoms via methine bridges (). In vertebrates, an essential member of the porphyrin group is heme, w ...

s are excreted in the human urine to an excessive degree. and orthomolecular psychiatrists have alleged that pyroluria is related to diagnoses of

ADHD Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder characterised by symptoms of inattention, hyperactivity, impulsivity, and emotional dysregulation that are excessive and pervasive, impairing in multiple ...

alcoholism Alcoholism is the continued drinking of alcohol despite it causing problems. Some definitions require evidence of dependence and withdrawal. Problematic use of alcohol has been mentioned in the earliest historical records. The World He ...

, depression, down syndrome, manic-depression,

celiac disease Coeliac disease (British English) or celiac disease (American English) is a long-term autoimmune disorder, primarily affecting the small intestine. Patients develop intolerance to gluten, which is present in foods such as wheat, rye, spel ...

epilepsy Epilepsy is a group of Non-communicable disease, non-communicable Neurological disorder, neurological disorders characterized by a tendency for recurrent, unprovoked Seizure, seizures. A seizure is a sudden burst of abnormal electrical activit ...

, and

. Pfeiffer's methods have not been rigorously tested, Available a
the internet archive.
Retrieved on 2008-02-17 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

''Histadelia'' is a condition hypothesised by Carl Pfeiffer to involve elevated serum levels of

histamine Histamine is an organic nitrogenous compound involved in local immune responses communication, as well as regulating physiological functions in the gut and acting as a neurotransmitter for the brain, spinal cord, and uterus. Discovered in 19 ...

and

basophils Basophils are a type of white blood cell. Basophils are the least common type of granulocyte, representing about 0.5% to 1% of circulating white blood cells. They are the largest type of granulocyte. They are responsible for inflammatory reactio ...

, which he says can be treated with

methionine Methionine (symbol Met or M) () is an essential amino acid in humans. As the precursor of other non-essential amino acids such as cysteine and taurine, versatile compounds such as SAM-e, and the important antioxidant glutathione, methionine play ...

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

''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 The National Institute of Mental Health (NIMH) is one of 27 institutes and centers that make up the National Institutes of Health (NIH). The NIH, in turn, is an agency of the United States Department of Health and Human Services and is the primar ...

and

American Academy of Pediatrics The American Academy of Pediatrics (AAP) is the largest professional association of pediatricians in the United States. It is headquartered in Itasca, Illinois, and maintains an office in Washington, D.C. The AAP has published hundreds of poli ...

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.; as cited in

References

Bibliography

* * * * {{cite book , last=Werbach , first=Melvyn R , title=Nutritional influences on mental illness: a sourcebook of clinical research , publisher=Third Line , location=Tarzana, California , year=1999 , isbn=978-0-9618550-8-6

External links

Orthomolecular Medicine Online
Orthomolecular medicine Treatment of mental disorders Treatment of bipolar disorder