Niacin & Schizophrenia

Niacin & Schizophrenia

I mentioned a few days ago the death of Dr. Hoffer, who promoted a theory of the biochemistry of schizophrenia that argued that it was caused by a failure of the epinephrine metabolism process. Drs. Hoffer & Osmond argued that significantly better cure rates could be achieved for schizophrenia by the use of high doses of niacin, and eliminating caffeine, sugar (and, I think, white bread) from a schizophrenic's diet. Because Dr. Harvey Ross used this "orthomolecular therapy" with my brother in the early 1980s--with very positive results, at least for a couple of years--I have always been disappointed at how little effort was made to replicate these claims.

I was having a conversation with my daughter the social worker about this, and she wondered if anyone was still using orthomolecular therapy for schizophrenia--since all the treatment that she sees is antipsychotic medicines. My curious got the best of me, and I started hunting around with scholar.google.com--and found some very interesting stuff. While I didn't find any indications that niacin is being experimented with for treatment, there is something very different between schizophrenics and others in how they react to niacin. From the abstract of a 2006 article:

This study compares the skin reactions to the niacin flushing test of 16 schizophrenic patients with those of 17 depressed patients and 16 healthy controls. Methyl nicotinate (niacin) in a concentration of 0.1 M was applied to the forearm for 5 min. Significant differences could be observed between the group of schizophrenic patients (less flushing) in comparison to the other groups. There were no statistical differences in niacin flushing between patients with depression and healthy controls. Gender, age and the use of antipsychotic agents did not appear to be confounders. The differences in flushing within the group of schizophrenic patients were striking, however. Most patients showed little or no flushing, but some patients reacted strongly. Although the three groups could be differentiated by the niacin flushing test, to develop a reliable clinical application of this test, further research is necessary.

Here's a 2007 article seeing if smoking played a role in the peculiar difference of how scizhophrenics responded relative to bipolar main and normal controls. And many other articles appear as well about how schizophrenics respond differently to niacin than others. This is clearly a hot research topic right now.

Now here is a startling article, published in 2009 in a journal whose title makes a bit nervous, but by a couple of doctors at Duke University Medical Center, where an attempt to help a long-term (in her 70s) obese schizophrenic female lose weight--unexpectedly and quite suddenly caused her hallucinations to end, literally, overnight, on the eight day. Okay, it's one patient alone, and there are in fact a lot of other mental disorders that are associated with vitamin deficiencies (such as Korsakoff's Disease, caused by thiamine defiency, and pellagra dementia caused by niacin deficiency). It is at least possible that this patient's hallucinations (involving skeletons) were actually some nutritional problem other than schizophrenia. But that article also references other studies suggesting that increased grain diets are correlated (on a regional or national level) with increases in schizophrenia.

Here's an article from Psychiatric Times (2006) that references recent studies involving vitamins for treatment of schizophrenia:

*Homocysteine and vitamin B redux*

High homocysteine levels have been found to interfere with NMDA receptors in animal studies. Neeman and coauthors⁴⁶ reported finding lower plasma glycine levels and higher homocysteine levels in patients with schizophrenia compared with controls, and glycine levels correlated with increased negative symptoms. Findings of higher homocysteine levels in patients with schizophrenia may often involve folate-deficient dietary choices, obesity, or cigarette smoking, but one study found that these variables explained relatively little of the high homocysteine levels.^47 In any case, remediation of high homocysteine levels with vitamin supplements is fairly straightforward, accomplished by adding high-dose folate, vitamin B_12 , and sometimes pyridoxine.

Recently, 42 individuals with schizophrenia who had high homocysteine levels received 3 months of treatment with vitamins or placebo in a crossover study. Those receiving the vitamins were found to have significant improvements in clinical symptoms as measured by PANSS and neuropsychological test scores, compared with placebo.^48

There's a LOT of current research out there on connnections between vitamins and schizophrenia.