Top-10 Optimal Mental Health Nutraceuticals
FISH OIL
INDICATIONS: Bipolar, Unipolar Disorders, ADHD, TBI, MCI, Psychosis.
DOSE: 2,000 - 3,000 mg daily, EPA:DHA.
SIDE EFFECTS: Increased bleeding, bruising.
CONTRAINDICATIONS: Surgeries and other medical procedures.
DESCRIPTION: There are lots of studies on fish oil for bipolar and unipolar mood disorders. Although there is some controversy over a modest amount of “negative” studies, meta-analyses do show that there are benefits in bipolar, unipolar, ADHD, TBI, MCI, and even preventing psychosis. Healthy polyunsaturated fats (PUFA’s) are essential components of cell membranes in the CNS, particularly for neurons and Schwann cells. The Standard American Diet (SAD) is very low in PUFA’s generally, and specifically, low in the ratio of Omega-3 fatty acids to Omega-6 fatty acids. For example, salmon is rich in Omega-3 while the ubiquitous corn found in the SAD is high in Omega-6. Although we need all three omegas (Omega-3, 6, and 9) in our diet, the 20:1 ratio of Omega-6 to Omega-3 in the SAD is far out of balance. This contributes to pro-inflammatory conditions that can underlie and/or exacerbate brain disorders and mental illness. Fish oil for mental health is usually prescribed in larger doses, focusing on the EPA content of the fish oil as the primary mood-benefitting ingredient as it has been shown to have mood-stabilizing and anti-depressant qualities. Although DHA has benefits for other diseases, it’s recommended to use fish oils for mental health with a EPA: DHA ratio of at least 1.5:1, or greater, in order to maximize benefits. It’s also important to note that not all supplements are created equal. Better fish oil brands are third-party tested for potential contaminants such as mercury. These include Pharmax, OmegaBrite, and Nordic Naturals. Poor products are often rancid and can cause fishy burps while higher quality products are often better tolerated.
DAILY ESSENTIAL NUTRITION (DEN)
INDICATIONS: Bipolar I, ADHD, Autism, PTSD prevention.
DOSE: 4 caps TID.
SIDE EFFECTS: Few reported, rare indigestion.
CONTRAINDICATIONS: None.
DESCRIPTION: A livestock feed scientist and pioneer in nutritional psychiatry, David Hardy, codeveloped in 1999 a 36-ingredient formula called “EmPowerplus” while he was a part of a supplement company called “True Hope.” EmPowerplus has been studied extensively in small clinical trials led by Julie Rucklidge PhD, Bonnie Kaplan PhD, and Charles Popper MD, ranging from ADHD, PTSD prevention, and Bipolar I disorder. David Hardy left TrueHope and reformulated the multi-ingredient formula without citrus bioflavonoid in order to reduce complications with medication tapers and named it, Daily Essential Nutrition (DEN). DEN formula can work in bipolar patients as a legitimate stand alone substitute for pharmaceutical mood stabilizers, e.g. LiCO3 and valproic acid. And this is a major boon to those bipolar patients who either do not tolerate conventional mood stabilizers or do not respond to them. DEN is also used for ADD/ADHD, especially for stimulant-naive people. It comes in capsules or powder, the latter being useful for children. Daily Essential Nutrition can also be used as a multivitamin in lower doses. Patients often report better quality sleep even on these lower doses.
SAM-E
INDICATIONS: Depression, Inflammation
DOSE: 400 - 800 mg daily, AM or early AM + late morning on an empty stomach
SIDE EFFECTS: Irritability, insomnia, mania in bipolar patients
CONTRAINDICATIONS: Bipolar disorder
DESCRIPTION: SAM-e (S-adenyl-methionine) is an important methyl group donor involved in a wide range of anabolic pathways. It is also a potent antidepressant that has been shown to cause switching to mania in people with bipolar disorder. For depressed patients who also have SNPs in methylation pathways (COMT and MTHFR c677t and a1298c), SAM-e combined with methylated B vitamins can address both issues. In patients without methylation issues, SAM-e can still be very effective as an antidepressant. Benefits typically result within the first week of treatment. Doses for depression are 200 mg to 800 mg a day, typically in the morning or divided between morning and noon. It can be activating or induce irritability or insomnia so better not to take at night. Recommend blister pack products, because it oxidizes quickly in air.
INOSITOL
INDICATIONS: Anxiety, Panic, Insomnia, OCD.
DOSE: 3 grams - 18 grams daily.
SIDE EFFECTS: Loose stools at daily doses >= 10 grams.
CONTRAINDICATIONS: None.
DESCRIPTION: Inositol is one of the most-utilized supplements for anxiety. It is effective, welltolerated, and tastes mildly sweet, which makes it suitable for kids as well as adults. Generally, it is dosed as a powder in a water bottle with instructions to sip throughout the day. This gives the added benefit of hydration. The adult starting dose is 2 - 3 grams per day. For folks who prefer capsules, it can be taken 3 or 4 times daily. As dosing of inositol increases, at some point there will be GI distress, soft stools or even diarrhea. For many, this threshold is about 10 grams a day. Tolerance of increased doses improves with gradual increases, such as one gram increases each week to effect, or to GI tolerance. There are a few small RCTs in which Inositol performed as well as SSRI and better than placebo on the YBOCS scale.
VITAMIN D
INDICATIONS: Low Vitamin D level.
DOSE: Depends on the level Less than 10: 20,000 IU daily for a month and recheck Less than 20: 10,000 IU daily for 3 months and recheck Less than 30: 5,000 IU for 3 months and recheck *800 IU RDA dose is inadequate to maintain a level in winter.
SIDE EFFECTS: None when blood level in normal range.
CONTRAINDICATIONS: Already high Vitamin D level.
DESCRIPTION: Studies show that MOST Americans have insufficient Vitamin D levels. Vitamin D3 is more a hormone than a vitamin.The structure contains a two ring arrangement like all cholesterol-based hormones. Low Vitamin D is associated with anxiety, depression, psychosis, cardiovascular disease, diabetes, bone fragility, autoimmune diseases, infections and several types of cancer. Its effect on the immune system is clearly important. Also, if your Vitamin D level is less than 20 (on a “normal” range of 30 to 100), you are unlikely to respond to conventional therapies for depression such as medication or psychotherapy. This also holds true for the treatment of hypothyroidism. Psychosis and / or severe depression can be caused by a 25-OH-Vitamin D3 less than 10. Having levels of Vitamin D at the higher part of the range, i.e. around 50 to 80, is a reasonable target.
CURCUMIN
INDICATIONS: Depression, Inflammation, Pain DOSE: 500 mg BID - 1000 mg BID.
SIDE EFFECTS: None.
CONTRAINDICATIONS: None.
DESCRIPTION: Curcumin is a very well-understood anti-inflammatory supplement used in Ayurvedic medicine for thousands of years. It is the active ingredient in the Indian spice turmeric. Its mechanism is the down regulation of Nuclear Factor Kappa beta (nf-K-b), a key master switch of inflammation in the body. It is very safe and well tolerated. As with any supplement sold in the USA there can be issues with adulterants so choosing a third-party tested product is recommended. Meriva is a type of curcumin preparation that tests well for absorption and purity. Several brands such as Thorne offer good Meriva products. Curcumin must be taken with ordinary black pepper (piperine) in order to maximize the absorption of the curcumin.
LITHIUM OROTATE
INDICATIONS: Depression, Anxiety DOSE: 5 mg - 20 mg BID.
SIDE EFFECTS: None.
CONTRAINDICATIONS: None.
DESCRIPTION: Municipal drinking water levels of lithium are inversely correlated with rates of homicide, suicide, burglary, and theft (Schrauzer 1990). Also, bipolar patients show significant increases in cortical gray matter thickness within the first 16 weeks of lithium treatment, while people treated with valproic acid do not show increased gray matter (In Kyoon Lyoo 2010). There is evidence that these neurotrophic and neuroprotective effects of lithium are sustained (Gildengers 2015). Finally, Lithium in drinking water in Japan was highly correlated with reduced all - cause mortality in a sample of > 1.2M people (Zarse 2011). Lithium supplementation has an excellent safety profile and large body of evidence supporting the anti-inflammatory and pro-health anti-aging effects of low doses of lithium on long-term brain health. Lithium orotate is not a substitute for lithium carbonate for bipolar I disorder. Nor does it suppress the thyroid gland in the above recommended doses. Lithium orotate could be one element of a treatment plan for bipolar I, in addition to other supplements and medications.
L-THEANINE
INDICATIONS: Anxiety, ADHD, Dementia prevention.
DOSE: 200 mg - 400 mg up to QID.
SIDE EFFECTS: Low risk of sedation at higher doses.
CONTRAINDICATIONS: None.
DESCRIPTION: L-theanine is an amino acid that occurs naturally at high levels in certain teas. As is commonly seen in nature, caffeine and L-theanine in tea balance each other. Caffeine is a stimulant while L-theanine is a relaxant. Interestingly, L-theanine is unlike any other tools for anxiety as it increases cognitive capabilities rather than dulling cognition. Several Japanese studies showed that L-theanine generally slows high beta EEG brain waves toward alpha frequencies, the latter being the brain waves associated with meditation or focused calm. L-theanine supports less frantic and distracted thoughts and more focus and relaxation.
MAGNESIUM
INDICATIONS: Insomnia, Anxiety, Muscle Tension.
DOSE: Insomnia: 200 mg - 1000 mg Mag citrate or threonate at bedtime Anxiety: 400 mg Mg glycinate TID to QID.
SIDE EFFECTS: Loose stools.
CONTRAINDICATIONS: Diarrhea, magnesium sensitivity.
DESCRIPTION: Inadequate magnesium intake is common, estimated in some studies to be as high as 60 to 70 percent of Americans. Magnesium plays a role in over 300 known enzymatic reactions in the body. Like other divalent cations such as calcium and lithium, magnesium is involved in maintaining ion gradients across cell membranes in the CNS. Most of the body’s Mg is located in muscle. Therefore, muscle tension and anxiety both respond well to magnesium supplementation. There is also evidence that magnesium deficiency predisposes to heart disease and metabolic syndrome/ type II diabetes (DiNicolantonio 2018). Magnesium appears to play an essential role in cognition, as evidenced by both animal studies (Slutsky 2010) and human studies (Ozawa 2012). All of this points toward the importance of maintaining adequate levels of magnesium for optimal mental and physical health. There are several versions of magnesium available for human consumption. Some cause more side effects (typically, diarrhea in the extreme form); however, there is a large therapeutic window with magnesium supplementation. It would be difficult to consume too much magnesium without incurring severe diarrhea so there is a natural deterrent. Magnesium sulfate is found in “Epsom Salts” for baths; however, it is not absorbed as well as other forms of magnesium, but stool softening is not a concern. Magnesium oxide is the ingredient in “Milk of Magnesia,” which is principally a laxative. Magnesium citrate or threonate are the two types most relevant to psychiatric practice with good bioavailability.
ASHWAGANDA
INDICATIONS: Adrenal fatigue, chronic stress DOSE: 200 mg - 300 mg BID.
SIDE EFFECTS: Possible impact on thyroid function.
CONTRAINDICATIONS: None.
DESCRIPTION: Ashwaganda, a.k.a. Withania somnifera, is a botanical herb which has been used in Ayurvedic medicine for thousands of years. It’s called an adaptogen because it supports the stress response, in both directions. Its principal use in integrative psychiatry is for the treatment of adrenal stress. Adaptogens act like stress buffers, increasing the necessary chemical responses to meet the needs of daily challenges, while diminishing over-reactivity to stress in those with less adrenal reserves. Adrenal dysfunction and abnormal cortisol production is usually present in people with chronic symptoms of mental illness. A large RCT testing Ashwaganda’s ability to lower serum cortisol levels produced a robust separation from placebo after 2 months in a cohort of people with chronic stress (Chandrasekhar 2012). Ashwaganda is safe and well-tolerated. There is one small study that reported an elevated risk of hyperthyroidism in a bipolar cohort taking Ashwaganda for cognitive enhancement; however, this effect seems to be rare.
* To the extent that any information is provided through this guide, it is for general informational purposes only and is not intended to constitute or substitute for (i) medical advice or counseling, (ii) the practice of medicine including but not limited to psychiatry, psychology, psychotherapy or the provision of health care diagnosis or treatment, or (iii) the creation of a physician-patient or clinical relationship (iv) individual supervision for medical professionals. If you have or suspect that you have a medical problem, contact your healthcare provider promptly. Information and statements regarding dietary supplements available in this guide have not been evaluated by the Food and Drug Administration and are not intended to diagnose, treat, cure, or prevent any disease. In the event that you use any of the information within this guide, which is your constitutional right, GINA GADISCHKE assumes and accepts no responsibility for your actions.