Updated: Feb 2
In March 2018, I sat in an absolutely packed large room in Boston's Westin Copley Place. Psychiatrists, psychologists, and nurses sat on every chair and every square foot of the carpeted floor and stood against every wall. All were attending the Child and Adolescent Psychopharmacology Conference sponsored by Massachusetts General Hospital.
Janet R. Wozniak, M.D. looked over the audience to whom she was to speak and asked of herself more than the audience, "Is it the topic or me?" Several of the audience, including me, shouted, "Both!"
Dr, Wozniak is the founding director of the Pediatric Bipolar Disorder Clinical and Research Program at Massachusetts General Hospital. She is an international expert. She is passionate and funny.
Besides Dr. Wozniak's expertise and charisma, the topic was current and compelling. The title of her evening presentation was "Naturopathic Treatment for Emotionally Dysregulated Youth."
Wikipedia explains "naturopathy or naturopathic medicine is a form of alternative medicine that employs an array of pseudoscientific practices ..." An example of naturopathic medicine is valerian root, used for anxiety disorders and insomnia.
In addition to speaking to naturopathic medications, Dr. Wozniak spoke to neutriceuticals.
Wikipedia defines a neutriceutical as "a pharmaceutical grade and standardized nutrient. In the US, 'neutriceuticals' do not exist as a regulatory category; they are regulated as dietary supplements and food additives by the FDA..."
I recommend neutriceuticals in my practice because the evidence base of safety and efficacy is growing. I recommend two excellent internet resources for anyone interested in neutriceuticals or naturopathic medicines. They are Examine.com at https://examine.com and ConsumerLab at https://consumerlab.com.
I suggest for my patients consideration of treatments consistent with concepts of Complementary Medicine, Integrative Medicine and Functional Medicine. For my patients two neutriceuticals prove to be particularly therapeutic, at times dramatically so. They are S-adenosylmethionine and N-acetylcsyteine. Both are variants of amino acids, the building blocks of proteins.
S-adenosylmethionine or SAM-e enhances two physiological processes in the body. They are methylation and transsulfuration. The latter process underlies SAM-e's significant effect on inflammation and arthritis. Although relief of pain and subsequent improved mobility can lead to wellbeing, SAM-e's main benefits for my patients are through methylation.
Methylation involves transfer of a methyl group in the myriad physiological reactions occurring in the body every moment. A methyl group consists of one carbon atom surrounded by three hydrogen atoms.
With the majority of psychiatric medications, the therapeutic activity is at the level of the synapse, the point of approximation of one neuron or nerve cell as it communicates with another.
SAM-e is different. SAM-e appears to enhance increased production of neurotransmitters within neurons related to an improvement in depression and increase in energy. Also SAM-e increases mitochondrial function. Mitochondria are "the powerhouses of cells" throughout the body.
N-acetylcysteine, or NAC, appears remarkably helpful for my patients suffering with an array of psychiatric disorders. It is the singularly most useful treatment I recommend, including all prescription medications. It too is an anti-inflammatory.
I witnessed my patients improve with bipolar disorder, panic disorder, obsessive-compulsive disorder, cannabis use disorder, and childhood-onset fluency disorder, usually referred to as stuttering.
I witnessed dramatic improvement in Hair-Pulling Disorder, otherwise known as trichotillomania. Previous to the use of NAC, I could provide modest benefit for my patients with the antidepressants and stimulants struggling with the disorder. NAC brings significantly greater improvement to my patients who suffer with disfiguring hair loss.
NAC benefits other disorders of excessive self grooming, such as nail biting and skin picking, Excoriation Disorder.
How can all these benefits come from NAC? At the October 2017 Psychopharmacology Conference sponsored by Massachusetts General Hospital, Michael A. Jenike, M.D. suggested the possible explanation. Dr. Jenike is the Founder of the OCD Institute at Massachusetts General Hospital and McLean Hospital. I was fortunate to speak to Dr. Jenike. I told Dr. Jenike that I describe him to my patients as "the planet's expert". He chuckled, but I think he knew I was right.
In the brain there are many more support cells than neurons or nerve cells, perhaps ten times as many. A group of support cells called glial cells serve multiple functions. The theory is that NAC enhances a function of glial cells. NAC increases the ability of glial cells to scan the synapses, that is the spaces between neurons, which utilize glutamate as the neurotransmitter or messenger to communicate from one neuron to another. Glial cells can diminish excessive glutaminergic activity.
What is so important about glutamate? Not only is glutamate a building block for protein, it is the most prevalent neurotransmitter in the central nervous system.
Glutamate plays an excitatory role. The second most prevalent neurotransmitter is gamma-aminobutyric acid, also referred to as GABA. Gamma-aminobutyric acid is inhibitory.
It stands to reason that modulating glutamate, the most prevalent excitatory neurotransmitter in the central nervous system, could have profound effects and significant implications for psychiatric disorders and neurological disorders.
Because neutriceuticals are not controlled by the Food and Drug Administration with the oversight equal to prescription medications, brands make a difference. I recommend Nature Made for SAM-e and Swanson, Solgar and Jarrow for NAC.
Now I offer to my patients for their consideration the body's own natural and efficacious medicines with safety profiles that only can be if they are already in the body. I share Dr. Wozniak's enthusiasm.