Towards an Understanding and Practice of Intravenous Orthomolecular Treatments for Mental Illnesses

Bradford S. Weeks, M.D. www.weeksmd.com md@weeksmd.com

Introduction
My thanks - powerpoint Topic: Setting the stage for IV therapies We will learn how to optimize orthomolecular treatment including IV protocols the dos and dont. How do we learn? Books? Experience? Teachers: Paracelsus, Steiner, Hoffer et al

Orthomolecular Medicine and Psychiatrys Practice Orientation and Goals

1) Behold the suffering patient as an individual person worthy of our respect who is working out his or her destiny and is honoring us by asking for the best we can offer to help the patient along the way; Reduce the Toxins Replenish the Beneficials

2) 3)

What is Orthomolecular?

Imagine sitting on a park bench and getting a splinter. Up come two doctors, one with pain medications and one with tweezers.

The doc offering to remove the splinter and dressing the wound (perhaps with raw honey) is the orthomolecular doctor.
using the correct molecules in the correct dosage Linus Pauling, Ph.D.

Ortho
Spirit - Soul - Etheric - Physical

Structure Molecular (Drs. Hoffer, Pauling et al)

O M & P as Inventory Control

Spirit
Soul Life
- decision - values - constant
- feelings passion - changeable

force - etheric - chi -biorhythms Physical Body - matter substance - biochem

There is no matter without spirit and there is no spirit without matter.
Dr. Rudolf Steiner

A Violin Recital needs:

A violin - the instrument (physical body) Someone to tune the violin (etheric body) Someone who enjoys playing music (the soul) Someone who once created a sonata or who can improvise extemporaneously (the spirit)

A Successful Sailing Voyage Requires:

A Boat (the physical body) Calk for the wood and patches for the sail (the etheric or regenerative body) Wind which is changeable (the soul) A Rudder to stay the course despite changes in wind and weather (the spirit)

Spirit

Not necessarily what church one attends. Who do you see in the mirror? What do you stand for? What are you committed to? What would you fight for? What do you want on your tombstone?

What virtually all cancer survivors, particularly the ones that had been undergoing conventional therapies, have in common is that they had a purpose to their lives with goals they absolutely needed to achieve, .no matter what.
A.H. Sartori, M.D. personal correspondence 2-04

Soul Body

Soul Food Inconstant Depleting Catabolic Burning the candle (at both ends!) Dominant when awake

We term sleep a death; and yet it is waking that kills us, and destroys those spirits that are the house of life.
Thomas Browne, 1643

Etheric Body

Chi Rhythm Restorative Regenerative Anabolic Waxing the candle Dominant during sleep

That we are not much sicker and much madder than we are is due exclusively to that most blessed and blessing of all natural graces, sleep.
Aldous Huxley

Physical Body

Structure Posture

and and

Molecule Function

Tissue

and

Biochemistry

Substance Inventory Control

Toxins / Stressors

Beneficials

Pollution

Oxygen

Electromagnetic Heavy metals (Hg, Pb, As etc.) Pesticides (xenoestrogens) Air Water

Open Airway Exercise for cleansing your weight in ounces AWAY from food Organic Food Supplements Enzymes Digestive Aids

Water

Hypoglycemia (popping the clutch) Sleep disturbances Addictive agents Pharmaceuticals (if inappropriate) The Daily News

Nutrients

Orthomolecular Medicine and Psychiatry

Which is is?
-Trickle up (the part conditions the whole ie. the molecules effect mood) or - Trickle down (the whole determines the part ie. the mood effects the molecules) Answer: both

ORTHO

Doctor as Good Samaritian

At the side of the road (and while taking a history in the office),

remember your Airway,

A, B, Cs !
Circulation

Breathing,

Conditions Ameliorated

Autism, Anxiety, ADHD, Apnea Bruxism Cancer, Chronic Fatigue Syndrome Depression, Diabetes Eczema Fibromyalgia, Fatigue Insomnia

Conditions Ameliorated
Multiple Sclerosis Neuropathies Arthritis Parkinsons Panic Attacks Schizophrenia Snoring Tourettes Syndrome

CARDIOVASCULAR AND SLEEP-RELATED CONSEQUENCES OF TEMPOROMANDIBULAR DISORDERS

NHLBI WORKSHOP

National Heart, Lung and Blood Institute NHLBI NHLBI Division of Heart and Vascular Diseases DHVD NHLBI National Center on Sleep Disorders Research NCSDR
December 3-4, 2001 Bethesda, Maryland FINAL REPORT

Inscription from Machavelli's Tomb

"There

is nothing more difficult to take in hand, more perilous to conduct, or more uncertain in its success, than to take the lead in the introduction of a new order of things."

Farrand Robson, DDS

Oral Systemic Balance (OSB) Tacoma, Washington

Frobson@ix.netcom.com

http://www.oralsystemicbalance.com

ORAL SYSTEMIC BALANCE

Homeostasis The equilibrium maintained by complex biological mechanisms via the autonomic nervous system to offset disrupting changes. Oral Systemic Balance The equilibrium between the mouth and the rest of the body via the autonomic nervous system needed to offset disruptive changes.

THE MOUTH AND JAW

IN NEUROMUSCULAR CONTROL OF THE THROAT

Holds The Tongue Maintain The Throat Supports The Ease of Oral Functions
Breathing Swallowing

Speaking

Are An Integral Part Of Homeostasis As They Contribute To The Oral Systemic Balance.

Case Study

11 year old boy in a wheelchair DX: MS, RA, ALS, toxic in vitamin A, malingering (father too)

Disposition: see a psychiatrist Stroke of Luck: saw a dentist

Patient Heal Thyself

Father read about a cure in Second Opinion Called the featured dentist, Farrand Robson Son was treated within the week Son arrived in a wheel chair and left walking (pushing his wheelchair) 5 hours later!

Lateral Cephalometric Films

SEE: throat closed vs. throat open

Case Study: 11 year old leukemia patient s/p chemotherapy with nausea, marked leg and head pain, heart rate of over 150 since chemo began. All these Sx resolved with OSB.

True Diagnosis: Airway Obstruction Choking

Etiology: Corrective Dental Surgery (cleft palate) shrunk the mouth leaving A 10 gallon tongue in a 5 gallon mouth

LESSON: Choking causes autonomic dysregulation which manifests as medical and psychiatric illnesses - check the airwayA,B,Cs!

Etiology:
If it werent for we dentists, you medical doctors would have nothing to do
Hal Huggins, DDS -personal correspondence, 1988

THE MOUTH AND JAW

IN NEUROMUSCULAR CONTROL OF THE THROAT

Holds The Tongue Maintain The Throat (airway) Supports The Ease of Oral Functions Are An Integral Part Of Homeostasis as Oral Systemic Balance is primary. The Dentist holds the ANS in his hands.

EPINEPHRINE FACILITATION OF JAW Muscle Function

Intense,

active, or collapse Feels on edge when at rest Feels on edge when distracted Functions well with moderate stressors creates stress when on vacation

The jawbones connected to the.

Autonomic Nervous System and the whole Unhappy Tongue goes into spasm and retreat to guard the throat back and down obstructing airway

What makes a Tongue unhappy ?

Being Cramped (braces, retainers) Cosmetic dental procedures (tongue forms the teeth for a reason) Pregnant crowns (block tongue coming up and out of the throat)

The Role of the Tongue

Remember

the homunculus

particular body region is represented on the cortex with an area that is proportional to the density of touch receptors in the body part, not by its actual size.

The Primacy of the Tongue

48%

of the sensory cortex is devoted to coordinating tongue and jaw movements in order to GUARD the THROAT and prevent CHOKING.

The new

ORAL history

Stressed out. but feel better with a little stress? Unable to relax? Busy Mind? Cant feel the here and now? Reading on the john?

The new

ORAL history

Do you relax with mild stimulants? - smoking (ammonia = smelling salts) - caffeine (respiratory stimulant) - Ritalin/ cocaine - fast driving? - weaving in and out of traffic
All these OPEN AIRWAYS !

Is the patient choking?

SIGNS holding breath chest (not belly) breathing receding jaw allergic shiners head tilt forward poor posture tachycardia hypoxemia (pulse ox) overbite (end stage) SYMPTOMS snoring apnea yawning/ sighing bruxism tornado sheets in AM restless legs motion sickness Clearing throat Nodding off when seated

JAW DYSFUNCTIONS EVALUATED:

Ease

of Swallowing Ease of Speaking Ease of Breathing

Ease of Swallowing
Have

a special way to swallow? Use various head and jaw positions for swallowing? Does food or pills get caught? Hair-trigger gag reflex?

Ease of Speaking
Words

mixed up when tired or not paying attention? Generally not crisp speech? softly speaking? Asked to repeat frequently? Stuttering?

Ease of Breathing
Out

of breath when sitting, walking or climbing stairs? Sigh / yawns frequently? Forgets to breathe? Shallow (chest vs. belly) breath?

Are YOU choking?

A. touch back teeth together lightly and pull chin in like you are saluting then check for resistance to breathing (watch chest)

- compare breathing with B. drop and relax the jaw, thrust the jaw forward so that the lower teeth are farther out than the upper teeth (watch belly)

Compensatory Conditions Consequent to Clenching !

Posture breakdown
Forward Head Posture Fibromyalgia Chronic Fatigue Myriad Pains

neck, shoulder, hip, back

Stayin Alive..
Forward

Head Posture
Effects

Epinephrine

Fast cars, motorcycles, sky diving, stimulant drugs,

nicotine, caffeine

Jaw

Muscle Activity

Bruxism, TMJ, Tongue out

Its not polite to stick your tongue out!

But it does get results

Michael Jordan Pete Sampras Andre Watts Brad Weeks Dogs

Parental Challenges

Tongue thrust -> buck teeth - push tongue back in mouth with spoon - suck on hard candy atop the hard palate - braces - retainers - crowns (and later dentures!)

Remember: the tongue forms the teeth and 48% of the sensory cortex cant be all wrong

ADHD

Elimination of dairy, wheat, corn, yeast, soy, citrus, egg, chocolate, peanuts, artificial colors, and preservatives) after just

two weeks, of children responded favorably as measured by the Conner Parent Rating Scale. The Annals of Allergy, Vol. 72, May 1994

73%

MOA for Food Allergies

Brain Edema? Increased heart rate ? (pulse test) Choking?

Vascular tongue bathed in an allergen becomes

edematous and swells. Nowhere to go but back and down into the throat against the trachea obstructing airway --> Agitation!

Systemic Edema associated with

Headaches PMS

States of Agitation
Schizophrenia Mania Panic Attacks ADHD Depression

for some reason my patients who are viciously choking feel and appear anxious.
If you found a drowning lady in the lake would it surprise you if she were thinking a lot about death and dying.
Dr. Farrand Robson

Unhappy Tongue and Airway

Can Disrupt and Impair the Nervous System Coordination:

Sensory Systems Autonomic Function

Motor Output
Sleep Architecture

Oral Systemic Balance

Homeostasis
The equilibrium maintained by complex

biological mechanisms via the autonomic nervous system to offset disrupting changes.

Oral Systemic Balance

The equilibrium between the mouth and the

rest of the body via the autonomic nervous system to offset disruptive changes.

Orthomolecular Benefits of Opening the Airway

Increased oxygenation of blood

- less hospitable for cancer - restoration of optimal blood pH

Optimization of enzymatic activity - less need for supplements Access to stage 3, 4 restorative and regenerative SLEEP

If your patient is agitated, 1) remember your A, B, Cs. 2) Do an ORAL History 3) Check the airway
before you medicate or supplement

The rest of your days begin(s) with the rest of your nights.

Sleep Disorders

Insomnia Excessive Daytime sleepiness Cataplexy/Narcolepsy Snoring Sleep Apnea

C-PAP and right sided heart damage

SLEEP DISTURBANCE AND NONMALIGNANT CHRONIC PAIN:

A Comprehensive Review of The Literature

Sleep Disturbances In 50-70% of Pain Patients The Most Common In

Headache Chronic Pain Fibromyalgia Rheumatic Diseases And Arthritis

Menefee, Pain Medicine. 2000;1

SNORING AND HEADACHE

260 Headache Days / Year In 206 Snorers 24 Headache Days / Year In 507 Others 24% In Headache Group Always Snore 14% In Non Headache Group Always Snore

Dr. Ann Sheer, National Institute on Aging May 2003 Journal of Neurology

Why we need to treat Insomnia

Insomnia can become a form of contemplation.

You just lie there, inert, helpless, alone, in the dark, and let yourself be crushed by the inscrutable tyranny of time.
Thomas Merton

My favorite Sleep Aid

Heavenly Morpheus, in vain do you wave the poppies; My eye will remain awake, if Amor will not close it.
Johann Wolfgang von Goethe

- Think abou tit. (sic)

My Favorite Orthomolecular Sleep Aid

Xyrem (GHB) back on the market

Only endogenous agent available that consistently

allows patients to achieve stage 3, 4 deep restorative and regenerative sleep; Not addictive Onset 15-45 minutes Duration 3-5 hours No AM sedation/confusion Starting dose 4 grams (8 ml) - MRX1 www.xyrem.info 1-866-XYREM-88

Sodium Oxybate: Development Milestones

1960s Sodium oxybate discovered Used in Europe for anesthesia (and ETOH detoxification) 1970s Clinical evaluation for narcolepsy

1980s Two independent controlled studies 1994 FDA approached Orphan Medical to develop sodium oxybate 2002 Sodium oxybate received FDA approval for cataplexy

Sodium Oxybate
Pharmacokinetics of an orthomolecular but prescription agent Xyrem aka GHB

Sodium Oxybate: Pharmacokinetics Summary

Absorption Dose proportionality Distribution Metabolism Tmax = 0.5 h-1.25 h Nonlinear kinetics <1% protein bound Bioavailability ~25% (hepatic first-pass metabolism) Diffuse cellular metabolism End product CO2 + H2O No active metabolite (no effect on cytochrome p450)

Elimination

Predominantly metabolized
~5% unchanged in urine T1/2 = 40-60 min (clears system fast and cleanly)

Food

Slows bioavailability - take on empty stomach

Metabolism
Rapid

absorption, short half-life, once or twicenightly dosing Nonlinear pharmacokinetics

Doubling dose yields 3-4 systemic levels; therefore,

dosing titrated
Renal

impairment: no effect expected Hepatic impairment: suggest dose by 50% Food slows bioavailability
Dose several hours after eating

No

pharmacokinetic tolerance w/ chronic HS use

Sodium Oxybate: Physiology

Endogenous

metabolite of GABA

Neuromodulator
GABA Dopamine Serotonin

of

Endogenous opioids

Evidence

for role as neurotransmitter

Synthesized in neurons, stored in vesicles, released via

depolarization into synaptic cleft, reuptake, specific receptors

Sodium Oxybate: CNS Pharmacology

Binds

to GABAB receptor

May play important role in pharmacologic activity at

therapeutic dosage levels

Antagonism of GABAB in animal models inhibits

sodium oxybateinduced sleep and some neuromodulation effects

Metabolic

effects (think hibernation)

Decreases cerebral glucose utilization (!!) Cerebral protective effects (!!)

Sodium Oxybate: DBPC Trial Efficacy in Cataplexy at Week 4

Placebo
10

Sodium oxybate dose (g) 3 6 9

Change from baseline Median (1st/3rd quartile) attacks/wk

0 -10 -20 -30 -40

N=136 Start. N=120 End. *P=0.0451 vs placebo; P=0.0016 vs placebo.

Stimulant medications maintained.

US Xyrem Multicenter Study Group. Sleep. 2002;25:42.

Sodium Oxybate: DBPC Trial Efficacy in EDS

Daytime Sleepiness (Baseline to End Point: Medians)
24

Epworth Sleepiness Scale

(medians 1st/3rd quartile)

22

Placebo B E

3.0 g B E

6.0 g B E

9.0 g B E

20
18 16 14
Narcolepsy Range

12
10 8 6
Normal Range P < 0.0001

N=136 Start. N=120 End.

Stimulant medications maintained.

US Xyrem Multicenter Study Group. Sleep. 2002;25:42.

Sodium Oxybate: Efficacy Conclusions

Consolidates nighttime sleep

Stage 3 and 4 sleep Delta power Nighttime awakenings

No evidence of tolerance with long-term use

Improves physician overall impression of clinical status

Improves patient perception of quality of life

Sodium Oxybate: Safety

Associated adverse effects include:

Withdrawals from controlled trials due to SE

6% sodium oxybate vs. 1% placebo

No evidence of withdrawal syndrome at therapeutic doses

No rebound insomnia

Supportive/symptomatic treatment of overdose

No evidence of dose escalation/abuse (unless daytime dosages) Not to be used with other sedatives

Sodium Oxybate: Airway and Ventilatory Effects

Patients with obstructive sleep apnea (OSA)

No specific study in OSA

No decrease in oxygen saturation in 6 patients

with OSA studied

All patients
No decrease in oxygen saturation
Ristanovic et al. Sleep. 2002;24(suppl):A473. Black et al. Sleep. 2002;24(suppl):A474.

Principles of IV Treatment Protocols

Test then Treat.

-Red Blood Cell Essential Fatty Acids -Plasma Amino Acids -Elemental Minerals
No more need to guess! Target deficiencies. Reduce toxicities. Tailor-made vs. generic replacement.

It is far easier to take measurements than it is to know what it is we are measuring.

Principles of IV Treatments
Primum non Nocere - Increased risk of acute events with IV Rx
- Use heparin and B-vitamins all the time

Buffering osmolality and managing pH Normal saline vs. sterile water vs. D-50 Concentrations / dosages (cookbook)

Why IV Protocols?
Benefits

Risks

Acute intervention Better absorption SAMe amino acids cationic minerals Enhanced Compliance Light at end of tunnel

More invasive Embolism Phlebitis Rapid conversions

tyrosine /phenylalanine

convert to dopamine-- a potential problem.

Modern Challenges
-Difficult to do in an office setting -Atypical anti-psychotics mask the illness -Most psychotic patients DO flush with oral niacin (use thiosalasilic acid) -Conclusion: many present as drug induced psychosis and not true schizophrenia;

Modern Challenges

(cont.)

Medical Legal issues

Competency

Guardianship
Informed Consent vs. Request for Care Follow-up care (PO, IM protocols)

Limitations of IVs

One IV treatment is not enough Not always easy to achieve IV access IM glutathione 100mg brain specific antioxidant
3 cc (hurts with muscle stretch) - less stress

IV glutathione oxidation - adrenochrome

IV Lipids

Supplementation with a combination of -3 fatty acids and antioxidants (vitamins E and C) improves the outcome of schizophrenia.
Meena Arvindakshana, Madhav Ghateb, et al.

Schizophrenia Research Volume 62, Issue 3 , 1 August 2003, p 195-204

Sources for IV Lipids

Essentiale

N - from Paracelsus Apoteke (Swiss) Fax 011-41-55-418-4071 Liposyn III (50% safflower/soybean)
From Apothecure (Texas) Tel 800-969-6601

Risks of IV Lipids

Embolism Phlebitis

Theoretical Rationale:

The greater the atomic diameter of alkali metals, the longer they persists in the NA-K channels thereby stabilizing the efflux of sodium ions out of the cell membrane.

Case Study: Mania

IV protocols for Mania

Magnesium and Vit B6 Glutathione Lipids Cesium 1-2mg max at 10mg (slow push) Side Effect: venous irritation

IV protocols for Anxiety

Meyers Cocktail Magnesium and B 6 slow push IV Vitamin C an anti-histamine

Case Study: Anxiety

Schizophrenia

Given Abram's theory of oxidative damage by the adrenochrome the use of IV antioxidants seems the most appropriate.

IV Protocols for Schizophrenia

Reducing adrenaline
Vitamin C

Methyl Donor
Niacin 100mg/cc RX 1-10cc with thiosalicylates, Vit C and
pantothenic acid B5

(Lysing the LSD - Hoffer personal correspondence)

Thiotic acid

Support membrane stabilization

Fatty acids

Correcting Imbalances
Per specific testing

Case Study: Schizophrenia

Depression

Pesticide & chemical exposure Fatty acid imbalances Heavy metal toxicity Hormonal imbalances Environmental and food Yeast overgrowth Amino acid imbalances

IV protocols for Depression

Essential amino acids: Freeamine, Essential fatty acids: Liposyn III Minerals: cesium, rubidium, magnesium etc. B vitamins
B 12, energy (shunts odd chained FA to Krebs cycle) B 6,

B 3, supports serotonin synthesis

B 5, adrenal support

Depression
SAMe injectable univials 200 and 400 mg. each. and must be reconstituted just before use. it makes a huge sense to use it parently because it is poorly absorbed by mouth. just as reduced glutathione. as opposed to lipoic acid which is very easy absorbed by mouth. Thioctic and NAC easy too

Alkali metals listed by molecular weight Potassium Lithium Rubidium Cesium

Rubidium
Pharmacologic Role of Rubidium in Psychiatric Research
Robert Williams

Comprehensive Psychiatry 1987 13 (9) 46-54

Alkali Metals A Comparison

Rubidium

Lithium

Increases spontaneous motor activity Increases EEG activity Affects K+ mediated physiology Antagonizes ETOH induced narcosis Increases norepinepherine turnover Catacholamine degradation primarily via Omethylation pathway Elicits anti-manic response Depression-Potassium-Rubidium

Decreases spontaneous motor activity Decreases EEG activity Affects Na+ mediated physiology Potentiates ETOH induced narcosis Decreases norepinepherine turnover Catacholamine degradation primarily via deamination pathway Elicits anti-manic response Mania Sodium- Lithium

Case Study: Depression

Depression FreeAmine In 500mg nl saline Lithium chloride 1-2mg (note: low Li in NW soil) Rubidium 1-10mg Calcium Trace Minerals B vitamins

Summary
Dr. Hugh Reardon genes trickle up Dr. Rollo May - spirit - trickle down

We have considered ORTHO as applies to all aspects of the patient and remembered fundamentals to be applied while giving orthomolecular supplements.

REMEMBER
A,

B, Cs

Airway, Breathing & .Cleep

Paracelsus Oath: This is my Vow: To perfect my medical art and never to swerve from it so long as God grants me my office, and to oppose all false medicines and teachings. Then to love the sick, each and all of them, more than if my own body were at stake. Not to judge superficially, but by symptoms, nor to administer any medicine without understanding, nor to collect any money without earning it. Not to trust any apothecary, nor to do any violence to any child. Not to guess, but to know. Paracelsus 1493 - 1541

Polling Our Peers

Saul Pilar, M.D. High doses of glutathione moderate doses of l-methionine (not dl-methionine !!! ) glycine glutamine taurine