A review article and meta-analysis of 18 articles published in the journal of Psychological Medicine reported effects of vitamin and mineral supplements on psychiatric symptoms of people diagnosed with schizophrenia. The study provides evidence of the benefits of taking certain vitamins and minerals for improving symptoms associated with schizophrenia.
“Vitamin B interventions which used higher dosages or combined several vitamins were consistently effective for reducing psychiatric symptoms, whereas those which used lower doses were ineffective.”
As Kaplan and Rucklidge have highlighted extensively in their writing, there has historically been evidence to suggest that nutrition and nutrient supplementation can be effective in improving symptoms associated with ‘mental illness.’ A review of scientific literature from 1910 to 2006 reveals that a wide range of nutrients have been studied in relation to psychotic symptoms, including all the B vitamins, vitamins C, D, and E, calcium, chromium, iron, magnesium, zinc, selenium, choline, and others.
Also previously highlighted by MIA, the exploration of nutrient imbalance and the relationship to psychotic symptoms has been discussed extensively in the work of Dr. Abram Hoffer. In an interview with Rob Wipond, Dr. Hoffer described his work in treating patients with niacin and B-3, suggesting patients do better with the supplements than with drugs alone. The present study adds to our understanding of the relationship between nutrient supplements and psychotic symptoms.
Authors of this new study sought out to explore the efficacy of vitamin and mineral supplements for schizophrenia, which nutrient strategies are most effective, and how patient characteristics might impact the effectiveness of nutrient supplements. Firth et al. conducted a review and meta-analysis of randomized controlled trials (RCTs) that reported effects of nutrient supplements for people with non-affective psychosis.
‘Nutrient supplements’ refer to any vitamins and essential mineral supplements administered along with common medications. Outcome measures included total symptoms change scores and modifications in individual symptoms assessed by various symptom scales (Positive and Negative Symptom Scale, Brief Psychiatric Rating Scale, and the Clinical Global Impression Scale). 99.5% of participants had a diagnosis of schizophrenia/schizoaffective disorder, and the remaining .5% had a diagnosis of bipolar disorder. All of the nutrient supplements in these studies were administered as an adjunctive to antipsychotic medication.
Of the studies included, seven assessed the effects of supplementing with Vitamin B (Vitamin B6, folate, folic acid with vitamin B12, folic acid with B6 and B12). The pooled RCTs found a significant positive effect on total symptom scores. Further analysis of the effect of vitamin B on individual domains found no significant effect of B vitamins on positive or negative symptoms. Three studies provided data on the effects of vitamin B6. This meta-analysis did not find a significant effect of solely supplementing with B6, nor was there an effect on positive and negative symptom subdomains. The analysis of vitamin B9(folate) alone or folic acid plus B12 found no significant effect on symptoms scores. This meta-analysis also saw no overall effect of inositol supplementation on symptom scores.
However, there were improvements for participants who entered the studies with low blood folate and those who had elevated homocysteine levels. Those with low blood-folate who received 15 mg daily of methylfolate for six months saw significant improvement in symptoms scores, and those with elevated homocysteine levels saw a significant reduction in symptom scores after three months of vitamin B combination supplementation. Outpatients also saw greater effects of B vitamin supplementation. The authors of this study add emphasis to the finding that Vitamin B was significantly related to illness duration. Patients who received B6 supplementation sooner after the onset of symptoms saw a greater improvement in symptoms.
Six studies assessed the effects of supplementing with antioxidant vitamins (vitamin E, vitamin C, and vitamin E and C combined). There was no effect of antioxidant vitamins on total symptom scores. There was also no effect of vitamin E alone on total symptoms scores. Supplementation of antioxidants was equally effective in outpatient and inpatient groups.
The only study which assessed the effect of taking vitamin C alone did see significant reductions in Brief Psychiatric Rating Scale (BPRS) symptom scores after eight weeks of treatment with 500 mg of vitamin C daily. Moreover, from studies which reported antipsychotic dosages, lower doses were associated with more symptomatic improvement.
Two studies included in this review and meta-analysis assessed the effects of supplementing with minerals (zinc and chromium). There was no overall effect, however, in one study, there was a significant improvement when 150 mg of zinc were administered every day for six weeks. A comparison of receiving 12 weeks of chromium treatment to placebo found no significant difference in symptom ratings.
Overall, this study highlights that some patients, who may be experiencing nutrient deficiencies, benefit significantly from supplementing usual treatment with nutrient supplements. This has been particularly evident in the studies of Vitamin B, where those who administered higher doses of vitamin B reported better effects in reducing psychiatric symptoms. The study authors add:
“The hypothesized mechanisms for these improvements is the reduction of folate deficiencies and hyperhomocysteinaemia, as both of these are prevalent among people with schizophrenia, and could contribute to impaired mental health and brain functioning in this population”
Further, the finding that vitamin B supplementation was most effective when administered earlier adds support for early intervention with vitamins and minerals. Similar findings of the benefits of early supplementation have been found in studies of fish oils for people with a first episode of psychosis and in preventing the transition from “clinically-high-risk” to a first-episode.
“The first-episode phase may be an optimal period for using adjunctive nutrient supplements to improve mental health. . .”
This study adds to the literature providing evidence for the beneficial effects of vitamin and mineral supplements for improving psychotic symptoms and draws attention to the relationship between nutrient deficits and symptoms associated with ‘mental illness.’ As mentioned earlier, the claim that nutrient supplements can improve symptoms is not novel. Authors of this study call for further research on the benefits of nutrient supplements to identify optimal supplementation for persons experiencing psychotic symptoms.
MIA Editor’s Note: An overview of orthomolecular psychiatrist Dr. Abram Hoffer’s life and work, along with his final public interview before his death, is available on Rob Wipond’s website.
Firth, J., Stubbs, B., Sarris, J., Rosenbaum, S., Teasdale, S., Berk, M., & Yung, A. R. (2017). The effects of vitamin and mineral supplementation on symptoms of schizophrenia: a systematic review and meta-analysis. Psychological Medicine, 1-13.(Abstract)