It was May 19, 2003, in San Francisco; the first-ever (we think) symposium on micronutrient treatment to be on the schedule for the annual meeting of the American Psychiatric Association. Dr. Charlie Popper, a psychiatrist at Harvard, organized it. The other three speakers were all PhD researchers: Bernard Gesch from Oxford Univ, David Benton from Univ of Swansea in Wales, and Bonnie from the Univ of Calgary. Bonnie remembers it was held in a fairly large room, it was about half full, and there was moderate interest.
But of course, we had so little data 12 years ago compared to today! Dr. Gesch spoke about his very important clinical trial of nutrients for aggressive behaviour in prisons, now replicated by Zaalberg in the Netherlands. Dr. Benton spoke about his rigorously controlled trials in University of Swansea students. And Bonnie spoke about the few case series and case studies that had been generated in Calgary as of that date.
Flash forward 12 years to May 20, 2015, APA in Toronto. Dr. Popper was again the symposium organizer, speaking about the biological rationale for the treatment of mental health symptoms with nutrients; another psychiatrist (Dr. Barbara Gracious from Ohio State) talked about safety and toxicity issues regarding nutrients; and the two of us (both psychologists) presented many, many studies on the use of micronutrients to treat anxiety, stress, depressive symptoms, ADHD, aggression, mood, and addictions.
Yes, the amount of data differed dramatically from 12 years ago, but the biggest difference was the response from psychiatrists!
This year we were in a very large room of about 200 chairs, about 175 of which were filled. When asked, ~95% said they were clinical psychiatrists. And even though our symposium had been scheduled in a terrible time slot (last one on the last day, after many people had gone home), there was such interest!
This conference was huge: 14,000 attendees, with more than 500 different sessions in 150 different rooms. Topics varied greatly, although we were surprised at how few described new or innovative treatments.
There were some other talks on issues related to diet, and also on issues related to the failures of medications. There was a talk on the best news stories of 2014, most of which seemed to be reversing former medical advice, such as that after all the advice to eat low fat and drink non-sugary drinks, the evidence now suggests that drinking beverages with aspartame is probably worse for our health. A session on the future of antidepressant drug discovery and development given by Dr. Florian Holsboer from the Max-Planck Institute for Psychiatry provided a convincing description of new ways to move forward that might target the stress system, new receptor sites and identifying those who might respond via genetic testing. He argued for personalized medicine as the way of the future, perhaps acknowledging that with our current approach, it is nearly impossible to identify who will respond to medications and who won’t.
Of course there was still a reluctance to accept the inadequacies of psychiatric medications. For example, a talk by Dr. Charles Nemeroff (Univ of Miami) focused on how to treat those who are treatment resistant. Despite acknowledging the sober reality of the STAR*D trial, in which regardless of how many drugs a patient was tried on, remission rates were still unacceptably low, the discussion focused largely on what other drugs to try, what doses, how to manage noncompliance, and how to manage side effects. As another example, Dr. Barbara Coffey (New York Univ) gave an overview of challenges in child and adolescent psychopharmacology, showing some sobering data on the poor outcomes of children on antipsychotics, the severe weight gain issues and metabolic problems. However, in her review of stimulants, she didn’t mention the results from Janet Currie’s study on Quebec children that has shown that community use of stimulants has resulted in no real benefits and that they actually carry some potential harm. Her review of the MTA trial focused on the growth restriction effects of stimulant medications, and did not discuss the lack of long-term efficacy of stimulants.
There were also two talks on diet as prescription, great advice on how to manipulate diet to improve the mental health of patients (participants were also given oysters to shuck and seaweed to eat). Too bad these talks represented less than one per cent of all the talks given at APA. Interestingly, the room for that session was packed to overflowing, showing that some psychiatrists are genuinely interested in non-pharmaceutical approaches.
There was also an inspiring talk by Dr. Moshe Szyf (McGill Univ) about the malleability of our DNA methylation system that can be changed based on environmental exposure — and of course our diet constitutes a critical category of epigenetic factors. Dr. Szyf reported that these environmentally-induced changes seem far more predictive of outcome than the actual stressor itself.
And so, back to our own symposium: What did we accomplish? Dr. Popper and both of us have received a small flood of follow-up emails (Bonnie counted 20 on her iPhone even before our symposium had ended!). These have been primarily from psychiatrists wanting some of the published studies we described, wanting to know more about the broad-spectrum formulas that have been researched, and asking to go on our email mailing lists. This is all a very good sign.
So we wonder; are psychiatrists truly ready to choose as their primary treatment the use of nutrients and other lifestyle interventions that cause no harm and often result in benefit?