Letter to the Editor - Dr. Charles Popper
Journal of Clinical Psychiatry Articles
December 6, 2001 Edition
Read the abstract on the National Library of Medicine website or read the editorial review of the actual Journal articles below.
Summary of Dr. Popper's Study
In his commentary on Dr. Kaplan's research titled, Effective Mood Stabilization With a Chelated Mineral Supplement: An Open-label Trial in Bipolar Disorder, Dr. Charles Popper shared his observations from his clinical practice:
“My interest in this nutrient mixture was initially sparked by a case in my clinical practice. A 10-year-old with bipolar disorder was referred for treatment of severe temper tantrums, which had lasted for two to four hours daily for four months. The well-nourished child had no prior psychiatric history or treatment. After 2 days on the nutrients, his tantrums showed significant improvement, with the father-psychiatrist reporting a "complete" absence of outbursts or even irritability at 5 days. After 2 weeks, the available supply of the nutrient supplement was exhausted, and tantrums returned within 48 hours. A similar supplement, containing most of the same ingredients, was then started and produced a moderate improvement, which parents and teachers estimated as 60% of the original effect. When restarted on the original formula, the symptoms were judged to have again responded completely. This naturalistic A-B-A-C-B trial caught my attention because of the full stabilization without psychiatric medications and the absence of observed adverse effects.”
“I proceeded to cautiously conduct additional trials of the Hardy-Stephan nutrient supplement. Among 22 patients who clinically met criteria for bipolar disorder, 19 cases showed what I judged to be a positive response (2 mild, 7 moderate, 10 marked improvement). Among the 15 drug-treated patients, 11 patients have been stable for 6-9 months without psychiatric medications. These observations are consistent with Kaplan's open-label findings…”
The fact that Dr. Popper's results were consistent with Dr. Kaplan's is indeed encouraging news, particularly since his symptom reduction rate was 86%, with a significant percentage of drug-treated patients (73%) stable, without psychiatric medications.
Dr. Popper also calls for more study into ‘nutrition-behavior' reactions. “Even allowing for the usual overestimation of effects in open-label series, these preliminary findings raise interesting questions about nutrition-behavior interactions. Kaplan's open-label report justifies her now on-going controlled study, whose outcome appropriately precedes pursuing questions of mechanism of action and parsimony.”
“(My) observations are consistent with Kaplan's open-label findings, but leave open questions of safety. Even though it contains only "natural" ingredients and is not under FDA purview, the Hardy-Stephan nutrient supplement should be examined in controlled empirical research -- just as new pharmacological agents are -- to properly assess adverse effects and potential risks. Psychiatrists do not normally think of vitamins or minerals as modifiers of the effects of psychiatric medications, but the early anecdotal experience with this nutrient supplement suggests that there may be strong micronutrient-medication interactions. This mineral-vitamin supplement seems to generally potentate the clinical properties of psychiatric drugs. Most patients in Kaplan's study could be managed with less medication after the nutrient supplement was added” he wrote.
Dr. Popper also signaled the need for more study into ‘transitioning' patients from medications to micronutrients. “In my observations, transitioning patients from medications to micronutrients is exceedingly tricky to manage. Introducing micronutrients too quickly can increase the adverse effects of medications, including agitation, while withdrawing psychiatric medications too quickly can result in symptom exacerbation. Often, both increased adverse effects and symptom resurgence are seen at once. Much more data is needed about how to "transition" patients who are currently taking psychiatric medications.“
Synergy welcomed these observations: ”Based on our knowledge and experience we fully concur with Dr. Popper's cautionary note. As the nutritional supplement normalizes the brain's chemistry, it is critical that clinicians and their patients be aware of these interactions. That is why we consistently urge participants to work with their clinicians in order to ensure safe and effective monitoring. We strongly recommend that those desiring to reduce or eliminate psychotropic medications be under competent medical supervision,” they said.
In closing his article, Dr. Popper said: “If Kaplan's preliminary findings are confirmed in controlled research, and if safety studies are favorable, what then? What if some psychiatric patients could be treated with inexpensive vitamins and minerals rather than expensive patented pharmaceuticals? Or if some doses of psychiatric drugs could be reduced by the concurrent use of nutrients? The economic implications, for individual patients and for the pharmaceutical industry, are difficult to overlook. For now, micronutrient treatments and other nutritional approaches remain in a very early scientific stage of investigation. Depending on how this line of research develops, clinicians and researchers may need to re-think the traditional bias against nutritional supplementation as a potential treatment for major psychiatric disorders.”
David Hardy and Tony Stephan responded to the study results: “This study is an important step in the evolution of our efforts to help the mentally ill. While we have seen similar results with the participants in our open-label series, we knew it was crucial to the supplement's wider legitimacy to have its performance measured and scrutinized in a scientific setting. We are grateful to the University of Calgary and to Dr. Popper for taking the time to study the supplement's impact on the mentally ill. The decision to research the supplement was entirely theirs and the beneficiaries of this work will be the mentally ill.”
The Alberta Children's Hospital Foundation and the Alberta Science and Research Authority supported this study.
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