Expert: Glen Aukerman, M.D. - 3/24/2008

Question
Hello, my 18 year old son has severe OCD. We tried many different treatments including alternative throughout the years but without any success. We are going to start him on some supplements. For example,  
Theanine 500 mg. - 3000 mg a day
GABA 500 mg - 3000 mg a day.
Could you please help me with following questions that I have:
1. What supplements and dosages would you recommend?
2. If we start with the smaller dosage, how long do we need to wait (1 day, 1 week, ???) before we know that we need to increase the dosage. Let's say if there is no difference for 5 days, would we need to increase the dosage then?
3. How much do we need to increase each time (let's say we start with 500 mg and our max is 3000 mg, should we increase by 500 mg every tine or double the dosage or ???)?   
4. How long does it normally take to see any improvement? Let's say if we don't see any improvement after being on this protocol for a month, does it mean this protocol is not working in our case?
5. If we do see an improvement, how long do we need to stay on the protocol and should we start decreasing the dosage at some point?   

Thank you!!!
Irina  

Answer
We would not use those but look at his CBC and diff to indicate the dose for each item. see the articles below for other ideas
1 - 12 of 12One page.
1: Int J Neuropsychopharmacol. 2008 Mar 14;:1-15 [Epub ahead of print]Related Articles, Links  
The role of 5-HT2A and 5-HT2C receptors in the signal attenuation rat model of obsessive-compulsive disorder.

Flaisher-Grinberg S, Klavir O, Joel D.

Department of Psychology, Tel Aviv University, Ramat-Aviv, Tel Aviv, Israel.

Serotonin 5-HT2A and 5-HT2C receptors have been implicated in the pathophysiology of obsessive-compulsive disorder (OCD) and in the mechanism mediating the anti-compulsive effects of serotonin reuptake inhibitors. Yet it is currently unclear whether activation or blockade of these receptors would have an anti-compulsive effect. The present study tested the effects of 5-HT2A and 5-HT2C activation and blockade in the signal attenuation rat model of OCD. In this model, 'compulsive' behaviour is induced by attenuating a signal indicating that a lever-press response was effective in producing food. Experiments 1-4 revealed that systemic administration of the 5-HT2C antagonist RS 102221 (2 mg/kg) selectively decreases compulsive lever-pressing, whereas systemic administration of the 5-HT2A antagonist MDL 11,939 (0.2-5 mg/kg) or of the 5-HT2A/2C agonist DOI (0.05-5 mg/kg) did not have a selective effect on this behaviour. Experiments 5 and 6 found that systemic co-administration of DOI (0.5 mg/kg) with MDL 11,939 (1 mg/kg) or with RS 102221 (2 mg/kg) had a non-selective effect on lever-press responding, with the former manipulation increasing and the latter manipulation decreasing lever-pressing. Finally, experiment 7 demonstrated that administration of RS 102221 directly into the orbitofrontal cortex also exerts an anti-compulsive effect. The results of these experiments suggest that blockade of 5-HT2C receptors may have an anti-compulsive effect in OCD patients, and that this effect may be mediated by 5-HT2C receptors within the orbitofrontal cortex.

PMID: 18339223 [PubMed - as supplied by publisher]

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2: Nutr J. 2008 Jan 21;7:2.Related Articles, Links   
Nutritional therapies for mental disorders.

Lakhan SE, Vieira KF.

Global Neuroscience Initiative Foundation, Los Angeles, CA, USA. slakhan@gnif.org

According to the Diagnostic and Statistical Manual of Mental Disorders, 4 out of the 10 leading causes of disability in the US and other developed countries are mental disorders. Major depression, bipolar disorder, schizophrenia, and obsessive compulsive disorder (OCD) are among the most common mental disorders that currently plague numerous countries and have varying incidence rates from 26 percent in America to 4 percent in China. Though some of this difference may be attributable to the manner in which individual healthcare providers diagnose mental disorders, this noticeable distribution can be also explained by studies which show that a lack of certain dietary nutrients contribute to the development of mental disorders. Notably, essential vitamins, minerals, and omega-3 fatty acids are often deficient in the general population in America and other developed countries; and are exceptionally deficient in patients suffering from mental disorders. Studies have shown that daily supplements of vital nutrients often effectively reduce patients' symptoms. Supplements that contain amino acids also reduce symptoms, because they are converted to neurotransmitters that alleviate depression and other mental disorders. Based on emerging scientific evidence, this form of nutritional supplement treatment may be appropriate for controlling major depression, bipolar disorder, schizophrenia and anxiety disorders, eating disorders, attention deficit disorder/attention deficit hyperactivity disorder (ADD/ADHD), addiction, and autism. The aim of this manuscript is to emphasize which dietary supplements can aid the treatment of the four most common mental disorders currently affecting America and other developed countries: major depression, bipolar disorder, schizophrenia, and obsessive compulsive disorder (OCD).Most antidepressants and other prescription drugs cause severe side effects, which usually discourage patients from taking their medications. Such noncompliant patients who have mental disorders are at a higher risk for committing suicide or being institutionalized. One way for psychiatrists to overcome this noncompliance is to educate themselves about alternative or complementary nutritional treatments. Although in the cases of certain nutrients, further research needs to be done to determine the best recommended doses of most nutritional supplements, psychiatrists can recommend doses of dietary supplements based on previous and current efficacious studies and then adjust the doses based on the results obtained.

Publication Types:
Review

PMID: 18208598 [PubMed - indexed for MEDLINE]

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3: Actas Esp Psiquiatr. 2006 Nov-Dec;34(6):403-7.Related Articles, Links  
[Differential diagnosis of hoarding behaviors]

[Article in Spanish]

Lahera G, Saiz-González D, Martín-Ballesteros E, Pérez-Rodríguez MM, Baca-García E.

Hospital Príncipe de Asturias, Alcalá de Henares, Madrid.

Hoarding of objects comprises a continuum from normality to extreme disease. It is important to distinguish between the different disorders that include hoarding behaviors. Compulsive hoarding is a form of obsessive-compulsive disorder (OCD) that is characterized by excessive acquisition of possessions, inability to discard possessions, and excessive clutter. Patients usually display other obsessive features, feel distress if they cannot hoard objects, show a typical cognitive pattern with obsessive features, and their interpersonal relations are mediated by objects. Diogenes syndrome is the combination of severe self-neglect, domestic squalor, social withdrawal, hoarding, and refusal of help, in elderly patients. There is high comorbidity with psychiatric/somatic disorders. Depression and dementia are risk factors for self-neglect. Collectionism is a normal phenomenon that is common in children but also found in adults. It is usually an organized activity, and the objects are kept in specific and structured places. The aim of collecting is to organize and hierarchize a series of objects, not just to hoard them. Collected objects are frequently appreciated by other collectors, and become exchanged to enlarge the collection.

Publication Types:
English Abstract

PMID: 17117338 [PubMed - indexed for MEDLINE]

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4: Pharmacopsychiatry. 2006 Jul;39(4):154-6.Related Articles, Links   
Generalised urticaria in a young woman treated with clomipramine and after ingestion of codfish.

Gallelli L, De Fazio S, Corace E, De Sarro G, Garcia CS, De Fazio P.

We report a case of generalized dermatitis and itch induced by a possible drug-food interaction in a young woman who was consuming clomipramine for Obsessive Compulsive Disorder (OCD). A 33-year-old woman affected by anxiety symptoms presented to our observation for a clinical evaluation. After psychiatric evaluation, the diagnosis of OCD was performed according to DSM-IV-TR and a pharmacological treatment with clomipramine (75-100 mg/day) plus alprazolam (0.5 mg/day) was started. About one month later, the patient developed a severe generalized urticaria with intense itch. A new anamnesis revealed that on the day before the development of the skin rash, no other drug was consumed and the patient had eaten codfish; clomipramine was then gradually discontinued and changed into paroxetine (30 mg/day). At the moment the patient does not show any OCD related symptom and any adverse event to paroxetine treatment has been recorded. We postulate a possible interaction between clomipramine and codfish ingestion. Allergic potential of clomipramine was investigated, while clomipramine de-challenge induced a decrease of the skin rash, the drug re-challenge performed one month later did not induce any adverse event. In contrast, when the combined re-challenge of codfish and clomipramine was performed urticaria was newly observed. The Naranjo Probability Scale Score suggested a probable causal relationship between drug-food interaction and the skin rash. In conclusion, we suggest evaluating also the complete risk of drug-food interaction occurring on clomipramine treatment.

Publication Types:
Case Reports
Letter
Research Support, Non-U.S. Gov't

PMID: 16871472 [PubMed - indexed for MEDLINE]

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5: Behav Res Ther. 2007 Feb;45(2):263-76. Epub 2006 May 12.Related Articles, Links   
Multimodal assessment of disgust in contamination-related obsessive-compulsive disorder.

Olatunji BO, Lohr JM, Sawchuk CN, Tolin DF.

Department of Psychology, Vanderbilt University, 301 Wilson Hall, 111 21st Avenue South, Nashville, TN 37203, USA. bolatunji@partners.org

The present study utilizes multiple methods to examine the relationship between disgust and contamination-related obsessive-compulsive disorder (OCD) symptoms in an analogue sample. Questionnaire findings revealed that participants with high OCD contamination concerns showed stronger disgust sensitivity than did participants with low OCD contamination symptoms after controlling for negative affect. High OCD participants (N=30) also reported significantly more disgust than did low OCD participants (N=30) when exposed to a disgust-inducing video, whereas no significant between-group differences were detected on other negative emotional dimensions. Results from a series of disgust-specific behavioral avoidance tasks (BATs) revealed that high OCD participants demonstrated both less compliance and less approach behavior. Subsequent analysis also revealed that disgust sensitivity generally mediated avoidance on the BATs among high OCD subjects. High OCD participants also rated the BATs as more fearful and disgusting than did low OCD participants, with disgust generally emerging as the dominant emotional response. The results are consistent with a disgust-based, disease-avoidance approach in understanding contamination-related OCD themes.

PMID: 16697976 [PubMed - indexed for MEDLINE]

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6: J Anxiety Disord. 2005;19(7):767-79.Related Articles, Links   
The distinctiveness of compulsive hoarding from obsessive-compulsive disorder.

Grisham JR, Brown TA, Liverant GI, Campbell-Sills L.

Center for Anxiety and Related Disorders, Boston University, MA 02215, USA. jgisham@bu.edu

The present study investigated the relation of compulsive hoarding to other obsessive-compulsive disorder (OCD) symptoms in a sample of 162 patients with OCD. Obsessions and compulsions reported on the Anxiety Disorders Interview Schedule for DSM-IV were submitted to an exploratory factor analysis. Results suggested a four-factor model: "Certainty," "Contamination," "Obsessions," and "Numbers/Ordering." Hoarding did not load on any factor. The sample was divided into three groups: pure hoarding, nonhoarding OCD, and mixed OCD and hoarding. The hoarding group endorsed significantly less anxiety, worry, stress, and negative affect on self-report measures than the mixed and nonhoarding groups. Although hoarding sometimes functions as a compulsion among individuals with OCD, hoarding in the absence of other OCD symptoms may be a clinically distinct syndrome.

Publication Types:
Comparative Study

PMID: 16076423 [PubMed - indexed for MEDLINE]

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7: Crit Rev Food Sci Nutr. 2005;45(3):145-64.Related Articles, Links
Nutraceutical therapies for degenerative joint diseases: a critical review.

Goggs R, Vaughan-Thomas A, Clegg PD, Carter SD, Innes JF, Mobasheri A, Shakibaei M, Schwab W, Bondy CA.

Connective Tissue Research Group, Faculty of Veterinary Science, University of Liverpool, Liverpool, United Kingdom.

There is growing recognition of the importance of nutritional factors in the maintenance of bone and joint health, and that nutritional imbalance combined with endocrine abnormalities may be involved in the pathogenesis of osteoarthritis (OA) and osteochondritis dissecans (OCD). Despite this, dietary programs have played a secondary role in the management of these connective tissue disorders. Articular cartilage is critically dependent upon the regular provision of nutrients (glucose and amino acids), vitamins (particularly vitamin C), and essential trace elements (zinc, magnesium, and copper). Therefore, dietary supplementation programs and nutraceuticals used in conjunction with non-steroidal, anti-inflammatory drugs (NSAIDs) may offer significant benefits to patients with joint disorders, such as OA and OCD. This article examines the available clinical evidence for the efficacy of nutraceuticals, antioxidant vitamin C, polyphenols, essential fatty acids, and mineral cofactors in the treatment of OA and related joint disorders in humans and veterinary species. This article also attempts to clarify the current state of knowledge. It also highlights the need for additional targeted research to elucidate the changes in nutritional status and potential alterations to the expression of plasma membrane transport systems in synovial structures in pathophysiological states, so that current therapy and future treatments may be better focused.

Publication Types:
Review

PMID: 16048146 [PubMed - indexed for MEDLINE]

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8: J Agric Food Chem. 2002 May 22;50(11):3222-7.Related Articles, Links   
Evidence for the biosynthetic pathway from sinapic acid to syringyl lignin using labeled sinapic acid with stable isotope at both methoxy groups in Robinia pseudoacacia and Nerium indicum.

Yamauchi K, Yasuda S, Fukushima K.

Graduate School of Bioagricultural Sciences, Nagoya University, Nagoya 464-8601, Japan. kazu@agr.nagoya-u.ac.jp

A tracer experiment using synthesized labeled lignin precursors was designed to confirm the actual biosynthetic pathway for syringyl lignin. Tetradeuteroferulic acid-[8-D, 3-OCD(3)] and heptadeuterosinapic acid-[8-D, 3,5-OCD(3)] were synthesized and fed to shoots of robinia (Robinia pseudoacacia) and oleander (Nerium indicum) trees. The incorporation of each labeled precursor into lignin was traced by gas chromatography-mass spectrometry. The synthesized sinapic acid, in which both methoxy groups were labeled, was useful in monitoring the conversion of sinapic acid into syringyl lignin. When heptadeuterosinapic acid was fed, syringyl units containing seven deuterium labels were detected. The results of this study support the traditionally accepted pathway that sinapic acid is converted to sinapyl alcohol via sinapoyl-CoA in robinia and oleander.

Publication Types:
Research Support, Non-U.S. Gov't

PMID: 12009990 [PubMed - indexed for MEDLINE]

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9: Psychopharmacology (Berl). 1998 Oct;139(3):239-42.Related Articles, Links   
Chronic dietary inositol enhances locomotor activity and brain inositol levels in rats.

Kofman O, Agam G, Shapiro J, Spencer A.

Department of Behavioral Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel. kofman@bgumail.bgu.ac.il

myo-Inositol has been found to be clinically effective in depression, obsessive compulsive disorder (OCD) and panic disorder when given chronically per os. The present study examined the effects of chronic dietary inositol in rats on locomotor behaviour. Regional brain levels of inositol were analyzed by gas chromatography. Chronic dietary inositol significantly enhanced locomotion and rearing in rats and elevated inositol levels by 36% in the cortex and 27% in hippocampus. No differences in inositol levels were found in the striatum or cerebellum. The stimulatory effects of inositol may be related to its effects as an atypical antidepressant in depressed patients.

Publication Types:
Research Support, Non-U.S. Gov't

PMID: 9784079 [PubMed - indexed for MEDLINE]

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10: J Clin Psychiatry. 1994 Oct;55(10):445-7.Related Articles, Links
Aberrant snacking patterns and eating disorders in patients with obsessive compulsive disorder.

O'Rourke DA, Wurtman JJ, Wurtman RJ, Tsay R, Gleason R, Baer L, Jenike MA.

Clinical Research Center, Massachusetts Institute of Technology, Cambridge.

BACKGROUND: Appetitive symptoms, particularly carbohydrate craving, have been shown to occur in patients whose conditions responded to treatment with drugs that enhance serotonin-mediated neurotransmission. This suggested that patients with obsessive compulsive disorder (OCD) who also frequently respond to serotonergic drugs also might have similar distributions of appetitive and eating patterns. METHOD: A survey study of 170 OCD patients and 920 controls was conducted using a questionnaire that inquired about snacking behavior, including food preference, mood changes after eating, and previous diagnosis of eating disorders. The frequency responses in the two groups were tested for statistical significance. RESULTS: Significant differences were found between the OCD and control groups with respect to the reported incidence of eating disorders, snacking patterns, and mood response to food. CONCLUSION: This finding of different snacking patterns in OCD mirrors that found in other disorders that have been shown to be responsive to serotonergic drugs. The high incidence of carbohydrate snacking among OCD patients compared with the control group provides additional evidence that brain serotonin may be involved in this disorder.

Publication Types:
Research Support, Non-U.S. Gov't

PMID: 7961522 [PubMed - indexed for MEDLINE]

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11: Aust Vet J. 1988 Feb;65(2):50-3.Related Articles, Links
Residues in beef cattle accidentally exposed to commercial heptachlor.

Petterson DS, Casey RH, Ebell GF, McIntyre BL.

Western Australian Department of Agriculture, South Perth.

The changes in concentration of heptachlor epoxide (HCE) and oxychlordane (OCD) were studied in the tissues of beef cattle that had previously grazed pasture contaminated with commercial heptachlor. In 25 cows and heifers monitored over 488 days, the mean concentration of HCE decreased from 22.0 to 0.08 mg/kg and of OCD from 5.68 to 0.18 mg/kg. The respective half-lives were estimated to be 66 and 92 days. In a controlled feeding experiment, nine steers were subjected to one of three dietary regimes; a high plane of nutrition for 81 days then a low plane for 140 days; a moderate plane of nutrition for the total period; and a low plane of nutrition for 81 days then a high plane for 140 days. Approximately five months later similar treatments were applied for 101 and 94 days. The rate of decline of HCE and OCD was consistently greatest in animals on the high plane of nutrition and lowest in those on the low plane. Lactation did not appear to have a major effect on the rate of decline in the tissue concentrations of these compounds. No significant (P greater than 0.05) relationships were found between the concentrations of HCE or OCD in the subcutaneous fat and either milk or blood at any stage of the experiment. At slaughter, from 18 to 24 months after the commencement of the experiments, significant correlations (P less than 0.05) were found among concentrations of HCE and OCD in subcutaneous fat, renal fat and fat from the bone marrow.(ABSTRACT TRUNCATED AT 250 WORDS)

PMID: 3355453 [PubMed - indexed for MEDLINE]

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12: Vet Pathol. 1987 Mar;24(2):109-17.Related Articles, Links
Effect of diet on longitudinal bone growth and osteochondrosis in swine.

Woodard JC, Becker HN, Poulos PW Jr.

Weanling gilts were fed either a 12% or 16% protein diet for 10 weeks. Animals fed the 12% protein diet had reduced body weights and reduced longitudinal bone growth as measured in the distal radial growth plate. There was no difference in the growth plate widths between the two animal groups, but there was a significant reduction in the daily rate of cell production in the proliferative zone of animals fed the 12% protein diet. No effect of diet on the rate of expansion of the epiphysis at the articular-epiphyseal junction of the distal femur or humerus could be detected. All animals in both groups had morphologic cartilage lesions consistent with early changes associated with osteochondrosis (OCD), and there was no difference in the lesion morphology between the dietary groups. Areas of disorderly endochondral ossification in the radial growth plate were associated with perpendicular growth cartilage infractions. Growth plate lesions were characterized by increased widths of the maturing cartilage zone without increased width of the proliferative zone or an increase in the daily rate of cell production. Focal growth plate lesions developed because of a transitory inhibition of cartilage mineralization and resorption. Disorderly foci of endochondral ossification beneath articular cartilage were characterized by an area of chondrocyte necrosis which prevented normal cartilage matrix mineralization. Lamellae of cartilage necrosis were also present within the reserve zone of the articular cartilage. These were associated with abnormalities of the cartilage canal vessels, and chondrocyte necrosis was considered to precede degenerative changes in articular cartilage matrix.(ABSTRACT TRUNCATED AT 250 WORDS)

Publication Types:
Research Support, U.S. Gov't, Non-P.H.S.

PMID: 3576905 [PubMed - indexed for MEDLINE]