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Principal Proposed Natural TreatmentsOther Proposed Natural TreatmentsHerbs and Supplements to Avoid


Schizophrenia

Schizophrenia is a chronic, severe, disabling brain disease. People with schizophrenia often suffer terrifying symptoms, such as hearing internal voices not heard by others, or believing that other people are reading their minds, controlling their thoughts, or plotting to harm them. These symptoms may leave them fearful and withdrawn. 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 other social problems such as unemployment, homelessness, and incarceration.
Schizophrenia is found all over the world. The severity of the symptoms and the long-lasting, chronic pattern of schizophrenia often cause a high degree of disability. Approximately 1% of the population develops this condition during their lifetime; more than 2 million Americans suffer from the 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 teens or early twenties, while women are generally affected in their twenties to early thirties.
Researchers aren’t sure what causes schizophrenia. Problems with brain structure and chemistry are thought to play a role. There appears to be a strong genetic component, but some researchers believe that environmental factors may contribute. They theorize that a viral infection in infancy and/or extreme stress may trigger schizophrenia in people who are predisposed to it.
Conventional drug treatment for schizophrenia is moderately effective. While it seldom produces a true cure, it can enable a person with schizophrenia to function in society.

Principal Proposed Natural Treatments

Untreated schizophrenia is a very dangerous disease for which there is effective treatment, and for this reason it is not ethical to perform studies that compare a hypothetical new treatment against 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 sole therapy for schizophrenia.

Glycine

Up 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 22 participants who continued to experience negative symptoms of schizophrenia despite standard therapy. 1 In this double-blind, placebo-controlled crossover study, volunteers were randomly assigned to receive either 0.8 g of glycine per kg of body weight (about 60 g per day) or placebo for 6 weeks, along with their regular medications. The groups were then switched after a 2-week "wash-out" period during which they all received placebo.
Significant improvements (about 30%) in symptoms such as depression and apathy were seen with glycine when compared to placebo. Additionally, glycine appeared to reduce some of the side effects caused by the prescription drugs. Furthermore, the benefits apparently continued for another 8 weeks after glycine was discontinued.
No changes were seen in positive symptoms (for instance, hallucinations), but it isn’t possible to tell whether that is because these symptoms were already being controlled by prescription medications or whether 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. 1-4
However, one small double-blind, placebo-controlled trial (19 participants) suggests that adding glycine to the drug clozapine may not be a good idea. 5 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. 6,37 Another recent study not specifically limited to clozapine also failed to find benefit with glycine. 43
Curiously, a natural substance (sarcosine) that blocks the action of glycine has also shown promise for schizophrenia. 34
For more information, including dosage and safety issues, see the full Glycine article.

Other Proposed Natural Treatments

Numerous other natural therapies have shown promise for aiding various aspects of treatment for schizophrenia, but, in most cases, the current 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, current evidence for benefit remains incomplete and inconsistent. 35,42
A small 6-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. 33 The results indicated that use of DHEA led to improvement in various symptoms, especially negative symptoms. However, in another double-blind, placebo-controlled study, use of DHEA provided minimal benefits if any. 40
Preliminary evidence suggests that ginkgo7,8 , the amino acid D-serine, 9 and N-acetyl cysteine44 may also enhance the effectiveness of various antipsychotic drugs.

Tardive Dyskinesia

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, or other movements of the face and limbs. TD can cause tremendous social embarrassment.
Several natural treatments have shown promise for preventing or treating TD. For more information, see the Tardive Dyskinesia article.

Other Drug Side Effects

Vitamin B6 might also reduce symptoms of akathesia, a type of restlessness associated with phenothiazine antipsychotics. 38
One small double-blind study found that use of DHEA reduced the Parkinson-like movement disorders that may occur in people taking phenothiazine drugs. 39
According to studies performed in China, the herb ginkgo may reduce various side effects caused by drugs used to treat schizophrenia. 7,13
Preliminary studies suggest that phenothiazine drugs might deplete the body of coenzyme Q 10 (CoQ 10 ) . 13,14 While there is as yet no evidence that taking this supplement provides any specific benefit for people using phenothiazines, supplementing with CoQ 10 might be a good idea on general principles.
The herb milk thistle might protect against the liver toxicity sometimes caused by phenothiazine drugs. 15

Other Options

Preliminary evidence suggests that a special form of magnet therapy called repetitive transcranial magnetic stimulation (rTMS) may be useful for schizophrenia. 16,17,45 However, not all studies have found benefits above the placebo effect; 36 rTMS is not yet available outside a research setting. See rTMS article for more details.
A study of 19 people with schizophrenia who had disturbed sleep patterns found that 2 mg of controlled-release melatonin improved sleep. 18
One small study failed to find the supplement creatine helpful for schizophrenia. 41
High doses of various vitamins, including folate , vitamin A , vitamin B 1 , vitamin B 3 (niacin) , vitamin B 6 , vitamin B 12 , vitamin C , and vitamin E have been suggested for the treatment of schizophrenia, but the evidence that they offer any real benefit remains incomplete and contradictory at best. 19-26
One trial of 81 adolescents and young adults (considered at very high risk for psychotic disorder) found that daily omega-3 fatty acid (fish oil) supplements for 12 weeks delayed the onset of a full blown schizophrenic episode. 46 An interesting result, but larger trials are necessary before fish oil supplementation can be recommended for patients at risk for shcixophrenia.
Yoga has also been studied for schozophrenia. In one small trial, patients who supplemented their regular treatment with a a yoga program lasting 4 months had improved symptoms, were able to function better, and reported a better quality of life compared to those who did physical therapy. 47
A review of 8 randomized trials involving 483 people with schizophrenia found that music therapy along with standard care helped to improve various measures of their mental state more than standard care alone. 48 These results, however, varied considerably across different studies depending on the quality and number of music therapy sessions.

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. 27,28
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. 29
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. If you take one of these drugs and then start taking St. John’s wort, your blood levels of the drug may fall. However, if you are already taking both the herb and the drug, and then you stop St. John’s wort, the level of drug in your body could reach the toxic point.
The supplement chromium is often sold in the form 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. 30,31
The herb yohimbe is relatively toxic and can cause problems if used incorrectly. Phenothiazine medications may increase the risk of this toxicity. 32

References

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2 Heresco-Levy U, Javitt DC, Ermilov M, et al. Double-blind, placebo-controlled, crossover trial of glycine adjuvant therapy for treatment-resistant schizophrenia. Br J Psychiatry. 1996;169:610-617.

3 Javitt DC, Zylberman I, Zukin SR, et al. Amelioration of negative symptoms in schizophrenia by glycine. Am J Psychiatry. 1994;151:1234-1236.

4 Semba J. Glycine therapy of schizophrenia; its rationale and a review of clinical trials [translated from Japanese]. Nihon Shinkei Seishin Yakurigaku Zasshi. 1998;18:71-80.

5 Potkin SG, Jin Y, Bunney BG, et al. Effect of clozapine and adjunctive high-dose glycine in treatment-resistant schizophrenia. Am J Psychiatry. 1999;156:145-147.

6 Evins AE, Fitzgerald SM, Wine L, et al. Placebo-controlled trial of glycine added to clozapine in schizophrenia. Am J Psychiatry. 2000;157:826-828.

7 Liu P, Luo H, Shen Y, et al. Combined use of Ginkgo biloba extracts on the efficacy and adverse reactions of various antipsychotics [translated from Chinese]. Chin J Clin Pharmacol. 1997;13:193-198.

8 Zhang XY, Zhou DF, Zhang PY, et al. A double-blind, placebo-controlled trial of extract of Ginkgo biloba added to haloperidol in treatment-resistant patients with schizophrenia. J Clin Psychiatry. 2001;62:878-883.

9 Tsai G, Yang P, Chung LC, et al. D-serine added to antipsychotics for the treatment of schizophrenia. Biol Psychiatry. 1998;44:1081-1089.

10 Peet M, Brind J, Ramchand CN, et al. Two double-blind placebo-controlled pilot studies of eicosapentaenoic acid in the treatment of schizophrenia. Schizophr Res. 2001;49:243-251.

11 Fenton WS, Dickerson F, Boronow J, et al. A placebo-controlled trial of omega-3 fatty acid (ethyl eicosapentaenoic acid) supplementation for residual symptoms and cognitive impairment in schizophrenia. Am J Psychiatry. 2001;158:2071-2074.

12 Emsley R, Myburgh C, Oosthuizen P, et al. Randomized, placebo-controlled study of ethyl-eicosapentaenoic acid as supplemental treatment in schizophrenia. Am J Psychiatry. 2002;159:1596-1598.

13 Folkers K. Basic chemical research on coenzyme Q 10 and integrated clinical research on therapy of diseases. In Lenaz G, ed. Coenzyme Q. New York: John Wiley and Sons; 1985.

14 Kishi T, Makino K, Okamoto T, et al. Inhibition of myocardial respiration by psychotherapeutic drugs and prevention by coenzyme Q. In: Folkers K, Yamagami T, Littarru GP, eds. International Symposium on Coenzyme Q. Biomedical and clinical aspects of coenzyme Q. Vol 2. New York, NY: Elsevier Science Publishing; 1980:139-157.

15 Palasciano G, et al. The effect of silymarin on plasma levels of malondialdehyde in patients receiving long term treatment with psychotropic drugs. Curr Ther Res. 1994;55:537-545.

16 Hoffman RE, Boutros NN, Hu S, et al. Transcranial magnetic stimulation and auditory hallucinations in schizophrenia. Lancet. 2000;355:1073-1075.

17 Rollnik JD, Huber TJ, Mogk H, et al. High frequency repetitive transcranial magnetic stimulation (rTMS) of the dorsolateral prefrontal cortex in schizophrenic patients. Neuroreport. 2000;11:4013-4015.

18 Shamir E, Laudon M, Barak Y, et al. Melatonin improves sleep quality of patients with chronic schizophrenia. J Clin Psychiatry. 2000;61:373-377.

19 Hawkins DR, Bortin AW, Runyon RP. Orthomolecular psychiatry: niacin and megavitamin therapy. Psychosomatics. 1970;11:517-21.

20 Hoffer A. Megavitamin B-3 therapy for schizophrenia. Can Psychiatr Assoc J. 1971;16:499-504.

21 Newbold HL, Mosher LR. Niacin and the schizophrenic patient. Am J Psychiatry. 1970;127:535-536.

22 Petrie WM, Ban TA, Ananth JV. The use of nicotinic acid and pyridoxine in the treatment of schizophrenia. Int Pharmacopsychiatry. 1981;16:245-250.

23 Petrie WM, Ban TA. Vitamins in psychiatry. Do they have a role? Drugs. 1985;30:58-65.

24 Procter A. Enhancement of recovery from psychiatric illness by methylfolate. Br J Psychiatry. 1991;159:271-272.

25 Vaughan K, McConaghy N. Megavitamin and dietary treatment in schizophrenia: a randomised, controlled trial. Aust N Z J Psychiatry. 1999;33:84-88.

26 Wittenborn JR, Weber ES, Brown M. Niacin in the long-term treatment of schizophrenia. Arch Gen Psychiatry. 1973;28:308-315.

27 Richardson MA. Amino acids in psychiatric disease. Washington, DC: American Psychiatric Press; 1990.

28 Mosnik DM, Spring B, Rogers K, et al. Tardive dyskinesia exacerbated after ingestion of phenylalanine by schizophrenic patients. Neuropsychopharmacology. 1997;16:136-146.

29 Schelosky L, et al. Kava and dopamine antagonism. J Neurol Neurosurg Psych. 1995;58:639-640.

30 Attenburrow MJ, Odontiadis J, Murray BJ, et al. Chromium treatment decreases the sensitivity of 5-HT(2A) receptors. Psychopharmacology. 2002;159:432-436.

31 Reading SA. Chromium picolinate. J Fla Med Assoc. 1996;83:29-31.

32 Brinker F. Herb contraindications and drug interactions. 2nd ed. Sandy, OR: Eclectic Medical Publications; 1998:140-141.

33 Strous RD, Maayan R, Lapidus R, et al. Dehydroepiandrosterone augmentation in the management of negative, depressive, and anxiety symptoms in schizophrenia. Arch Gen Psychiatry . 2003;60:133-141.

34 Tsai G, Lane HY, Yang P, et al. Glycine transporter I inhibitor, N-methylglycine (sarcosine), added to antipsychotics for the treatment of schizophrenia. Biol Psychiatry . 2004;55:452-6.

35 Peet M. Eicosapentaenoic acid in the treatment of schizophrenia and depression: rationale and preliminary double-blind clinical trial results. Prostaglandins Leukot Essent Fatty Acids . 2003;69:477-85.

36 Holi MM, Eronen M, Toivonen K, et al. Left prefrontal repetitive transcranial magnetic stimulation in schizophrenia. Schizophr Bull . 2004;30:429-34.

37 Diaz P, Bhaskara S, Dursun SM, et al. Double-blind, Placebo-Controlled, Crossover Trial of Clozapine Plus Glycine in Refractory Schizophrenia Negative Results. J Clin Psychopharmacol . 2005;25:277-278.

38 Lerner V, Bergman J, Statsenko N, et al. Vitamin b(6) treatment in acute neuroleptic-induced akathisia: a randomized, double-blind, placebo-controlled study. J Clin Psychiatry . 2004;65:1550-1554.

39 Nachshoni T, Ebert T, Abramovitch Y, et al. Improvement of extrapyramidal symptoms following dehydroepiandrosterone (DHEA) administration in antipsychotic treated schizophrenia patients: A randomized, double-blind placebo controlled trial. Schizophr Res . 2005 Aug 25. [Epub ahead of print]

40 Ritsner MS, Gibel A, Ratner Y, et al. Improvement of sustained attention and visual and movement skills, but not clinical symptoms, after dehydroepiandrosterone augmentation in schizophrenia: a randomized, double-blind, placebo-controlled, crossover Trial. J Clin Psychopharmacol. 2006;26:495-499.

41 Kaptsan A, Odessky A, Osher Y, et al. Lack of efficacy of 5 grams daily of creatine in schizophrenia: a randomized, double-blind, placebo-controlled trial. J Clin Psychiatry. 2007;68:881-884.

42 Berger GE, Proffitt TM, McConchie M, et al. Ethyl-eicosapentaenoic acid in first-episode psychosis: a randomized, placebo-controlled trial. J Clin Psychiatry. 2007;68:1867-1875.

43 Buchanan RW, Javitt DC, Marder SR, et al. The cognitive and negative symptoms in schizophrenia trial (CONSIST): the efficacy of glutamatergic agents for negative symptoms and cognitive impairments. Am J Psychiatry. 2007;164:1593-602.

44 Berk M, Copolov D, Dean O, et al. N-acetyl cysteine as a glutathione precursor for schizophrenia—a double-blind, randomized, placebo-controlled trial. Biol Psychiatry. 2008 Apr 22.

45 Tranulis C, Sepehry AA, Galinowski A, et al. Should we treat auditory hallucinations with repetitive transcranial magnetic stimulation? A metaanalysis. Can J Psychiatry. 2008;53:577-586

46 Amminger GP, Schäfer MR, Papageorgiou K, et al. Long-chain omega-3 fatty acids for indicated prevention of psychotic disorders: a randomized, placebo-controlled trial. Arch Gen Psychiatry. 2010 Feb;67(2):146.

47 Duraiswamy G, Thirthalli J, Nagendra HR, Gangadhar BN. Yoga therapy as an add-on treatment in the management of patients with schizophrenia—a randomized controlled trial. Acta Psychiatrica Scandinavica. 2007;116(3):226-232.

48 Mössler K, Chen X, Heldal TO, Gold C. Music therapy for people with schizophrenia and schizophrenia-like disorders. Cochrane Database Syst Rev. 2011;12:CD004025.

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