5th April 02:33
Inositol for Panic Disorder - anyone tried this supplement? (psychiatric psychiatry depression panic allergies)
Has anyone ever tried Inositol or other natural treatments as an
adjunct to theraphy or substitute to benzos or SSRIs?
Thought this article was interesting though I am not sure how valid
the data is! I question everything on the internet.
Natural Products in the Clinical Treatment
of Mental Illness
A Profile of Dr. James Greenblatt, MD
By Joe Leonard
Inositol is a naturally occurring isomer of glucose and a key
intermediate molecule of second messenger signal transduction pathways
used by serotonergic, cholinergic, and noradrenergic neurons. Inositol
is believed to play an important role in the intracellular
phosphatidyl inositol second messenger system to which several key
serotonin receptor subtypes are linked. As such, compounds containing
inositol may represent novel the****utic agents in treating some
Dr. James Greenblatt of McLean Hospital, a Harvard Medical School
teaching hospital, is currently using inositol supplementation as part
of the treatment of patients with mental illnesses, particularly
depression, panic disorder, and obsessive-compulsive disorder (OCD).
A considerable body of research is ac***ulating that inositol plays an
important role in treating these mental illnesses. Inositol is likely
involved in signal transduction pathways involving serotonin, a
neurotransmitter that becomes out of balance in several of these
illnesses. Inositol's efficacy in the absence of side effects makes it
an attractive addition to treatment plans for specific mood disorders.
Depressive patients show decreased levels of inositol in their
cerebrospinal fluid (Levine et al., 1997) and inositol has a similar
the****utic profile to pharmaceutical selective serotonin reuptake
inhibitors (SSRIs) often used to treat depression (Mishori et al.,
Serotonin plays a definitive role in OCD as well and Fux et al. (1996)
brought about significant improvement in OCD patients by
administration of 18 grams/day of inositol in a random, double-blind,
placebo-controlled study (p=0.04 relative to control).
Treatment with 12 grams of inositol per day (vs. placebo) has also
been shown to significantly reduce the severity and frequency of panic
attacks in patients with panic disorder (Benjamin et al., 1995) in a
double-blind, placebo-controlled, crossover experiment. The average
number of panic attacks per week fell from 10 to 3.5 in patients
Recently, Palatnik et al. (2001) completed a double-blind, controlled,
crossover trial of inositol vs. fluvoxamine (Luvox®, Faverin®) in the
treatment of panic disorder that reinforces previous research that
inositol is effective in treating this serious illness. Fluvoxamine is
an effective drug for treating panic disorder in the short term,
though its side effects of nausea and tiredness often cause patients
to stop taking it.
In this study, 20 patients taking inositol (up to 18 grams/day) showed
improvements on the Hamilton Rating Scale for Anxiety, agoraphobia
scores, and the Clinical Global Impressions scale, that were
comparable with fluvoxamine. In the first month of treatment, inositol
reduced the number of panic attacks per week by 4 compared with a
reduction of 2.4 per week with fluvoxamine, a significantly improved
outcome (p=0.049). Side effects were considerably less with inositol
than with fluvoxamine. This is the first comparison of inositol with
an established drug for treatment of panic disorder and suggests
inositol may be just as effective as some drugs in the treatment of
this disorder, with fewer side effects.
The side effects of inositol are minimal. It is speculated that
inositol's regulation of serotonin may enhance sleep and help patients
with insomnia, though there are not currently any valid clinical
studies to back this up.
The action of inositol in treating psychological disorders is largely
theoretical. Inositol is known to act as a second messenger for a
number of neurotransmitters in the brain. Antidepressant medications,
such as SSRIs, increase the amount of neurotransmitter in neuronal
synapses within 24 hours by blocking the receptors that sequester
them. However, Greenblatt points out that the psychological effects of
this inhibition can take 2-4 weeks to manifest, suggesting that second
messengers in the biochemical pathways of neurotransmission, such as
inositol, are likely to be involved.
Inositol is not considered an essential dietary nutrient, because it
is made in the body and is shuttled around to various tissues as
needed. Overconsumption of sugar, however, may disrupt the inositol
shuttle system and associated second messenger pathways, essentially
leading to deficiency.
Often, the patients that Greenblatt treats are not able to make
positive dietary changes, but he has shown that supranutritional doses
of inositol are effective in treating illnesses even when the diet is
lacking in some way. He has also used inositol in conjunction with
SSRIs, particularly where high doses of SSRIs cause sleep
disturbances. Inositol can be taken with the medication to alleviate
Greenblatt has used inositol effectively in treating
obsessive-compulsive disorder in both children and adults. He has been
able to use inositol to treat children with OCD without requiring any
other medical intervention. In adults he has used it alone to treat
In most clinical research trials, 10-18 grams of inositol are used in
treatment. Greenblatt reports that he rarely uses more than 10 grams
and in children he successfully uses much lower amounts, approaching
physiological doses (2 grams or less per day).
Greenblatt is excited about current research on inositol for treating
mental illnesses in children because it seems it sometimes can be used
alone without the need for pharmaceutical drugs. He is anxious to get
the word out to other psychiatrists who are reluctant to use a new and
purely nutritional product without the research to back it up. The
body of published literature on inositol in treating mental illness is
significant, but it still has not been incorporated into mainstream
clinical thinking because of the difficulty in getting past the heavy
drug company influence in mental health. A major academic question
Greenblatt asks is, why?
"There is scientific literature in peer reviewed psychiatric journals
demonstrating that inositol appears to work as effectively as SSRIs
(Prozac, Zoloft, and Paxil)," Greenblatt said. "Studies show
consistent improvement in symptoms, significantly better than
Because inositol is a natural substance that is safe and effective,
without significant side effects, Greenblatt believes it may be
particularly effective for use in the treatment of geriatric and
pediatric populations before addressing their illnesses with
Greenblatt has been interested in nutritional medicine since the early
1980s in medical school. He completed traditional training in adult
psychiatry and child psychiatry and believes medications play an
important role in mental health. However, he does not believe this
role should be primary to effective nutritional and dietary approaches
to treating illness.
One of Greenblatt's main goals is to educate mental health
professionals in the use of nutrition and dietary supplements as
alternatives to pharmaceuticals. Since the mid 1980s, he has treated
thousands of children with both therapy and medication, but during the
past 10 years he has become primarily interested in helping people
find alternative therapies for treating psychiatric disorders.
"Patients are looking for alternatives," he said. "They are going to
alternative practitioners and coming home with a list of perhaps 30
synthetic supplements to take for depression. There is little
scientific research to support the use of many of these supplements,
and more importantly, they are not getting better."
Greenblatt did an internship with allergist Marshal Mandel in the
1970s. His introduction to using alternative medicine in mental
illness was observing the behavioral responses of people to food
allergies. "I saw tapes of very sick patients, be it ADHD,
schizophrenia, or depression, before and after eliminating certain
foods that they were allergic to," Greenblatt said. "The differences
The future of inositol in mental health
In spite of the evidence that inositol is effective in treating mental
illness, the medical community is slow to adopt its use. In order to
get the word out, Greenblatt wants to examine inositol in a host of
pediatric disorders that are responsive to SSRIs: depression, panic
disorder, and OCD. He intends to repeat previous successful adult
studies on children. Inositol in pediatric OCD will be the first study
he plans to conduct. It may take a year or more to complete and two
years before appearing in a peer-reviewed journal.
"It is important to wait for scientific research," he said. "But it is
also OK to begin to utilize nutritional interventions that are not
harmful and appear to be the****utic. Inositol is often a third line
treatment for OCD. Medications are used first, and it doesn't make a
lot of sense that inositol is not used first, particularly in children
and geriatric populations [on whom drugs may have the most adverse
"What does it take for the medical community to accept inositol when
the research has been done? I don't know of any other nutrient in the
psychiatric literature that has undergone the kind of scientific study
that inositol has.
Many medications that we use in children are not approved for use in
children. Most have only been studied in adults, with not a single
study on children. Yet, we use them every day in children. We have no
idea how they affect brain development or if they even work when we
use them in children. Yet professionals are reluctant to use a safe
herbal or nutritional supplement just because they say, ‘There is no
research on it.'
"Up until a few years ago, all the antidepressants and neuroleptics
(antipsychotics) had never been studied in children," he said. "Now a
few studies are coming out like the use of Luvox for OCD in children.
These studies are funded by the drug companies. They are very short
and they do show some benefit, but we just don't know what their
effects are over time. In addition, whenever you treat these
disorders, particularly OCD, you always get a subset, sometimes 30% or
40%, that does not respond to medication. That is a whole other
segment of the population that could benefit from nutritional
Greenblatt recommends emphasizing nutrition with whole foods and whole
food concentrates with higher-dose supplementation in certain cases.
"The difficult concept is that what we want to recommend to our
patients is to stop eating sugar, junk food, and white flour, which is
going to help a large majority of our child patients," Greenblatt
said. "When you look at even the adult mentally ill patients, they are
just living on junk food. To address these lifestyle issues is clearly
the first goal. But, if they are not able to change their diet right
away, are there other alternatives that we can use? Clearly the food
we are feeding our children as a culture is destroying brain cells and
having an adverse effect on growth and development. The kids who are
biologically vulnerable to mental illnesses are going to develop them
at much earlier ages and I think in much more severe forms."
Dr. Greenblatt is also interested in the use of oligoproanthocyanidins
(OPCs) in the treatment of mental disorders, particularly for
Attention Deficit Hyperactivity Disorder (ADHD). OPCs have been used
for many years in Europe for vascular complaints such as hemorrhoids
and varicose veins. Greenblatt has seen improvements in the
electroencephalograms (EEGs) of patients with ADHD and improved
handwriting, attention, and behavior in children with ADHD, an effect
also observed with stimulant drugs used to treat ADHD.
"We have found that people respond to OPC whether or not they have a
diagnosis of ADHD," Greenblatt said. "They are generally more focused
and more attentive. Depressed patients show an improvement of mood and
energy level. PMS is a common complaint for which we have used OPC
with good success."
In treating ADHD with OPC, Greenblatt sees about a 60% success rate in
adults and slightly less than that in children. "It is not that every
patient gets better," Greenblatt said. "But for a non-medical
intervention it has been quite successful."
As a consequence of administering OPC to treat psychiatric illnesses,
Greenblatt is also hearing qualitative reports from patients of very
rapid improvements in joint pain that are noticeable within a couple
weeks of starting OPC. "Older patients will often report that the
joint pain they have had for 20 years is better," Greenblatt said.
"Then they will suggest it to their relatives. Joint pain has really
been probably the most dramatic improvement I have seen with the OPC."
The effect on joint pain may be because OPC prevents the breakdown of
collagen, a structural molecule in joints and blood vessels. This may
also explain why OPC is reported to improve varicose veins.
Diet is a major component of Greenblatt's supplement protocol. Adults
and children who can make positive dietary changes have a much higher
likelihood of success. "OPC sometimes can work without significant
dietary interventions and lifestyle changes, but clearly it works
better with those changes."
OPC is found in pine bark, g**** seed, Ginkgo biloba, and other plant
sources and a question arises as to what is the best source of OPC to
use the****utically. Clinically, Greenblatt has observed that some
people respond to one source of OPC better than another, but in
general patients do better taking a mixed source of OPC, such as OPC
Synergy™ (Standard Process Inc.).
Benjamin, J. et al. 1995. Double-blind, placebo-controlled, crossover
trial of inositol treatment of panic disorder. Am J Psychiatry 52:
Fux, M. et al. 1996. Inositol treatment of obsessive-compulsive
disorder. Am J Psychiatry 153(9): 1219-1221.
Levine, J et al. 1997. Controlled trials of inositol in psychiatry.
Eur Neuropsychopharmacol 7(2): 147-155.
Mishori, et al. 1999. Combination of inositol and serotonin reuptake
inhibitors in the treatment of depression. Biol Psychiatry 45:
Palatnik, A. et al. 2001. Double-blind, controlled, crossover trial of
inositol versus fluvoxamine for the treatment of panic disorder. J
Clin Psychopharmacol 21(3): 335-339.