Introduction
Schizophrenia is a disabling brain disease that is a chronic, severe, and believed to be genetic. People with schizophrenia often experience auditory hallucinations, such as hearing internal voices that are not heard by others. Paranoia is also common, and those suffering with schizophrenia often believe that other people are reading their minds, controlling their thoughts, or plotting to harm them. These symptoms often leave individuals fearful and withdrawn. Also, their speech and behavior can be so disorganized that they may be incomprehensible or frightening to others. Schizophrenia increases a person’s risk of suicide, self-mutilation, substance abuse, and social problems such as unemployment, homelessness, and incarceration.
The severity of schizophrenic symptoms and the long-lasting, chronic pattern of the disease often cause a high degree of disability. Approximately 1 percent of the population develops this condition during their lifetime; more than 2 million people in the United States have this illness in a given year. Although schizophrenia affects men and women with equal frequency, the disorder often appears earlier in men. Men are usually affected in their late teenage years or early twenties, while women are generally affected in their twenties to early thirties.
Researchers are not sure what causes schizophrenia, although in 2016 scientists published a report indicating that the disorder has its roots in an individual's DNA. Problems with brain structure and chemistry are thought to play a role, and some researchers believe that environmental factors may contribute. It is theorized also that a viral infection in infancy or extreme stress, or both, may trigger schizophrenia in people who are predisposed to the disease.
Conventional drug treatment for schizophrenia is moderately effective. Although it seldom produces a true cure, it can enable a person with schizophrenia to function in society.
Tardive dyskinesia (TD) is a potentially permanent side effect of drugs used to control schizophrenia and other psychoses. This late-developing (tardy, or tardive) complication consists of annoying, mostly uncontrollable movements (dyskinesias). Typical symptoms include repetitive sucking or blinking, slow twisting of the hands, and other movements of the face and limbs. TD can cause tremendous social embarrassment. Several natural treatments have shown promise for preventing or treating TD.
Principal Proposed Natural Treatments
Because there are effective treatments for schizophrenia, it is unethical to perform studies comparing a hypothetical new treatment with a placebo. Therefore, studies of natural treatments for schizophrenia have looked at their potential benefit for enhancing the effects of standard treatment (or minimizing its side effects). No natural treatments have been studied as a sole therapy for schizophrenia.
Glycine
. Until recently, all common medications used for schizophrenia fell into a class called phenothiazines. These drugs are most effective for the positive symptoms of schizophrenia, such as hallucinations and delusions. (Such symptoms are called positive because they indicate the presence of abnormal mental functions, rather than the absence of normal mental functions.) In general, however, these medications are less helpful for the “negative” symptoms of schizophrenia, such as apathy, depression, and social withdrawal.
The supplement glycine might be of benefit here. A clinical trial enrolled twenty-two persons who continued to experience negative symptoms of schizophrenia despite standard therapy. In this double-blind, placebo-controlled crossover study, volunteers were randomly assigned to receive either 0.8 gram(g) of glycine per kilogram of body weight (about 60 g per day) or placebo for six weeks, along with their regular medications. The groups were then switched after a two-week “wash-out” period during which they all received placebo.
Significant improvements (about 30 percent) in symptoms such as depression and apathy were seen with glycine when compared with placebo. Additionally, glycine appeared to reduce some of the side effects caused by the prescription drugs. Furthermore, the benefits apparently continued for another eight weeks after glycine was discontinued.
No changes were seen in positive symptoms (for instance, hallucinations), but it is not possible to tell whether this was the case because these symptoms were already being controlled by prescription medications or because glycine simply has no effect on that aspect of schizophrenia.
Four other small, double-blind, placebo-controlled clinical trials of glycine together with standard drugs for schizophrenia (including the newer drugs olanzapine and risperidone) also found it to be helpful for negative symptoms. However, one small, double-blind, placebo-controlled trial (nineteen participants) suggests that adding glycine to the drug clozapine may not be a good idea. In this study, glycine was found to reduce the benefits of clozapine without helping to relieve the participants’ negative symptoms. Lack of benefit, although no actual harm, was seen in two other double-blind, placebo-controlled trials of glycine and clozapine. Another, later study not specifically limited to clozapine also failed to find benefit with glycine. A natural substance (sarcosine) that blocks the action of glycine has also shown promise for the treatment of schizophrenia.
Other Proposed Natural Treatments
Numerous other natural therapies have shown promise for aiding various aspects of treatment for schizophrenia, but in most cases, the supporting evidence is weak at best.
Enhancing drug action. For a number of theoretical reasons, it has been suggested that fish oil and its constituents (especially a slightly modified constituent called ethyl-EPA) might enhance the effectiveness of standard drugs used for schizophrenia; however, evidence for benefit remains incomplete and inconsistent.
A small, six-week, double-blind, placebo-controlled study evaluated the potential effectiveness of the supplement dehydroepiandrosterone (DHEA) taken at a dose of 100 mg daily for enhancing the effectiveness of drug treatment for schizophrenia. The results indicated that the use of DHEA led to improvement in various symptoms, especially negative symptoms. However, in another double-blind, placebo-controlled study, the use of DHEA provided minimal benefits, if any. Preliminary evidence suggests that ginkgo, the amino acid D-serine, and N-acetylcysteine may also enhance the effectiveness of various antipsychotic drugs.
Drug side effects. Vitamin B6
might also reduce symptoms of akathesia, a type of restlessness associated with phenothiazine antipsychotics. One small double-blind study found that the use of DHEA reduced the Parkinson-like movement disorders that may occur in people taking phenothiazine drugs. According to studies performed in China, the herb ginkgo may reduce various side effects caused by drugs used to treat schizophrenia.
Preliminary studies suggest that phenothiazine drugs might deplete the body of coenzyme Q10 (CoQ10). While there is no evidence that taking this supplement provides any specific benefit for people using phenothiazines, supplementing with CoQ10 might be a good idea on general principles. The herb milk thistle might protect against the liver toxicity sometimes caused by phenothiazine drugs.
Other options. Preliminary evidence suggests that a special form of magnet therapy called repetitive transcranial magnetic stimulation (rTMS) may be useful for schizophrenia. However, not all studies have found benefits above the placebo effect; rTMS is not yet available outside a research setting.
A study of nineteen people with schizophrenia who had disturbed sleep patterns found that 2 mg of controlled-release melatonin improved sleep. Another small study failed to find the supplement creatine helpful for schizophrenia.
High doses of various vitamins, including folate, A, B1, B3 (niacin), B6, B12, C, and E, have been suggested for the treatment of schizophrenia, but the evidence that these vitamins offer any real benefit remains incomplete and contradictory at best. One trial of eighty-one adolescents and young adults (considered at very high risk for psychotic disorder) found that daily omega-3 fatty acid (fish oil) supplements for twelve weeks delayed the onset of a full schizophrenic episode. Larger trials are necessary before fish oil supplementation can be recommended for persons at risk for schizophrenia.
Yoga too has been studied for schizophrenia. In one small trial, persons who supplemented their regular treatment with a yoga program lasting four months had improved symptoms, were able to function better, and reported a better quality of life compared to those who did physical therapy alone.
Herbs and Supplements to Avoid
There are some indications that using the supplement phenylalanine while taking antipsychotic drugs might increase the risk of developing tardive dyskinesia. Antipsychotic drugs can cause dystonic reactions (sudden intense movements and prolonged muscle contraction of the neck and eyes.) There is some evidence that the herb kava can increase the risk or severity of this side effect.
Phenothiazine drugs can cause increased sensitivity to the sun. Various herbs, including St. John’s wort and dong quai, can also cause this problem. Combined treatment with herb and drug might increase the risk further.
St. John’s wort might also interact adversely with the newer antipsychotic drugs in the clozapine family. Persons who take any of these drugs and then start taking St. John’s wort may see blood levels of the drug fall. However, if a person is already taking both the herb and the drug, but then stops St. John’s wort, the level of drug in the body could reach the toxic point.
The supplement chromium is often sold as chromium picolinate. Because picolinate can alter levels of various neurotransmitters (substances that the brain uses to function), there are theoretical concerns that it could cause problems for people with schizophrenia.
The herb yohimbe is relatively toxic and can cause problems if used incorrectly. Also, phenothiazine medications may increase the risk of this toxicity.
Bibliography
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