Observations from Ira L. Goodman, M.D., FACS, ABIHM, FAARM, ABAARM
One of the many advantages of living in San Diego is the plethora of medical meetings
that rotates through. Last month I was invited to attend 2 back to back international
Mental Health conferences, which were remarkable more for their contrasting styles
than for their similar content.
The first was PSYCHCONGRESS which was held at the San Diego Convention Center.
It is one of the two large psychiatric meetings held annually and it attracted over 3000
attendees, mostly conventional psychiatrists. It was, as expected, heavily sponsored by
Big Pharma including lavish exhibits hawking every conceivable psychotropic drug in all
their varieties. The exhibit hall must have taken days to set up with custom carpeting,
cappuccino stands, “food” stands ( mostly items I would never consider consuming),
large video displays, attractive reps summoning passers-by into their areas, and even
street artists performing-anything to get the attention of their marks- the ones writing the
prescriptions. Even the poster area was basically one study after another comparing
one drug to another praising the sponsor’s product. There was one exhibit featuring a
folic acid product, but other than that there was basically no mention of anything like
diet, nutraceuticals, HRT, energy medicine, exercise, or lifestyle in the exhibit hall.
However, the lectures did have token coverage of lifestyle and one even mentioned the
microbiome but it was very rudimentary. There was one interesting moment when a
high functioning schizophrenic got up in front of 2000 psychiatrists and told her life story
which included multiple meds, hospitalizations, discrimination, and accomplishments.
She received a standing ovation when she thanked the psychiatrists . The patient
remarkably graduated from Yale Law school. and wrote a book. Apparently there are
rare schizophrenic patients who manage to overcome this disease. I also learned
something about the drug prazosin which is an alpha blocker typically used for BPH and
hypertension but can be used off label for PTSD and insomnia at very low doses. There
are now studies supporting this off label indication. Other than that I could not wait to
get out of this conference.. It was biased and commercial- not an atmosphere of
intellectual discovery or honesty.
The second meeting was the IMMH conference (Integrative Medicine for Mental
Health), an annual event attracting about 400 attendees from a variety of disciplines. I
fully admit to a functional medicine bias but this conference was one of the best I have
been to in years. Almost every lecture was on point, informative, and even enlightening.
The exhibits were a cornucopia of useful devices, supplements, home aids, and cutting
edge new companies displaying their wares. Each lecture was followed by a lively
question session which usually took thirty minutes or more as well as audience
discussions in separate groups. There were many fascinating topics covered including
integrative medicine for depression and anxiety, HRT and metabolic treatments for
mental health, food allergies, the microbiome effect on mental health, lithium as an
agent for cognitive function and mood, the latest thinking on autism, metabolic disorders
mimicking psychosis and other mental disorders, multiple sclerosis, cognitive decline,
and a new inflammatory marker PLA2. I cannot possibly report on all the lectures
adequately in this relatively small report but I will mention a few items of special interest.
One is the increasing use of low dose lithium (1-20mg po) for many different mental
disorders including cognitive decline, mood elevation, manic depression , and anxiety.
As most readers probably know, lithium has been used for years by conventional
psychiatry for bipolar disorder in doses of 300-600 mg/d with several significant side
effects. However these side effects can be mitigated with low doses of the drug and
lithium levels are not even measurable in the serum. Nevertheless, clinical benefits are
almost always evident including the avoidance of standard of care drugs which can be
very dangerous for a number of reasons. The beverage 7-UP used to have low dose
lithium in it until 1950. Lithium has a molecular weight of 6.94 so it was rounded off to 7
and the beverage was frequently advertised as a mood elevator, hence the name 7 UP.
In areas of the country with high lithium soil content, epidemiological studies show fewer
suicides and victims of depression. It is a naturally occurring element typically found in
hair sample even without supplementation. Several physicians (including Jonathan
Wright) have been using it for cognitive decline prophylaxis and mood elevation. This
mineral is worthy of any functional medicine practitioner’s toolkit.
Another noteworthy item I learned at this conference was the about the new
inflammatory marker PLA2 (phospholipase A2) which is measured in the urine by The
Great Plains Laboratory (although other labs are sure to follow). There are ten types of
PLA2 produced, nine of which are measurable in the urine and only one measurable in
the serum since the molecule is too large to make it through the kidneys ( lipoprotein
associated PLA2). The LpPLA2 that most functional medicine practitioners and some
cardiologists use is the one associated with vascular inflammation and is supposed to
portend a CV event. The other nine PLA2 molecules can indicate brain inflammation as
well as inflammation elsewhere. The exciting thing is that a new product called CDP
choline can reduce high PLA2 levels and presumably brain inflammation as well. It can
be used in many neurological degenerative conditions and even as a prophylactic
nutraceutical for brain health. This is cutting edge material developed and researched
by Dr William Shaw who gave several clear and convincing lectures at the IMMH
conference. His work on the association between Tylenol (acetaminophen) and autism
is groundbreaking and well worth viewing. Dr. Daniel Amen also gave a well received
lecture on his work with SPECT brain scans pointing out that psychiatry is the only
specialty that still practices like they did over 100 years ago without looking at the organ
they claim to be experts in. Dr Rouzier gave an excellent talk on the association
between hormone deficiencies (specifically testosterone and thyroid) with a number of
mental health issues.
I was a little disappointed that neither meeting mentioned the work of Robert Whitaker
that he describes in his 2 books Anatomy of an Epidemic and Psychiatry under the
Influence. Whitaker postulates that the introduction of psychotropics (starting with
thorazine in the 50s) resulted in dramatic increases in the incidence and severity of
mental health disorders due to the perturbation of the neurotransmitter levels which
results in permanent changes in receptor density and sensitivity in the brains of treated
patients. This creates a situation that leads to greatly increased recurrences of the
mental disorders the drugs temporarily ameliorate. This is exactly what is seen
epidemiologically. Neither meeting mentioned the work by Kirsch in his book The
Emperor’s New Drugs in which he proves that psychotropics work no better than
placebos. A more complete description of these 2 books is beyond the purview of this
article but I wanted to mention them here since they are highly relevant to any serious
student of this subject.
As an Advanced Fellow in Functional Medicine, Board Examiner, and author I found
these two conferences fascinating. Clearly my bias is toward less invasive, less toxic,
and more effective treatments in anything I am called upon to treat. This should be the
same motivation of any physician but the forces of industry create a cognitive
dissonance that seems almost impossible to overcome. It is my hope that the readers of
this article will be motivated to resist commercial influences and make logical choices
based on evidence and unbiased thinking.
— Last Edited by Health_Freedoms at 2015-11-03 09:41:09 —