Are micronutrients the answer to NZ’s mental health crisis?

'Caroline's doctor prescribed her Prozac, which her psychologist supported. She was reassured – but once she started ...

‘Caroline’s doctor prescribed her Prozac, which her psychologist supported. She was reassured – but once she started taking it she felt worse, with more extreme panic.’

Caroline was always someone who ran on nervous energy. But when a man began stalking her last year, harassing her for 10 months, the lawyer and mother of two developed a new kind of cell-deep fear that took over her mind.

“It has sucked so bad. More than anything,” she says, referring to the nine months of anxiety that followed. “I didn’t even know things could suck as bad as it sucked.”

It came on in stages. She’d have a day where she suddenly felt very disoriented, as though someone had put something in her drink. The next day she’d be fine.

“I felt my throat tightening, so I went to the doctor, and then to the ENT surgeon, but there was nothing.

READ MORE:
* What it’s really like to pop ‘happy pills’
* My anxiety is called Walter
* Being anxious makes it hard to identify others’ emotions

Julia Rucklidge's team is currently conducting a trial to see if micronutrients can improve depression and anxiety ...

Julia Rucklidge’s team is currently conducting a trial to see if micronutrients can improve depression and anxiety pregnancy. Register your interest at bit.ly/pregnancy-study.

“It was terrifying and strange and then it all fell apart and I got this crippling panic disorder: rolling panic, panic attack followed by panic attack, that went on for six weeks. When it came on it was like full alert: it was front line of the Iraqi special forces in Mosul. It was like that, but you’re just in your house.”

The stalker has stopped now, but he left behind a full-blown generalised anxiety disorder, something Caroline* now realises she’d caught glimpses of throughout her life. She says the symptoms are hard to describe – a staticky crackling in her ears, for one.

“It’s a terrible, unnerving, unending fear, something every molecule in your body experiences. My brain is fried.

“It’s not like just being nervous about exams – it’s a very powerful inability to calm down,” she says. “But it’s a difficult illness to communicate to the world. The number of times that people popped in and said: ‘You look fine! You look great!'”

Anxiety is a growing modern affliction. Although, whether that’s due to greater awareness, or because we really are experiencing a higher incidence of clinical-level panic than usual, is uncertain. Anxiety New Zealand estimates that a whopping one in four New Zealanders experience anxiety, panic attacks, and phobias every day.

Alongside that has come a well-documented rise in demand on a struggling national mental health system, as well as an international increase in pharmaceutical treatment. One in 10 adults in the developed world now takes an antidepressant. In June it was reported that the number of New Zealand children and teens on them has doubled over the past 10 years, with nearly 15,000 prescribed them last year.

Psychiatric medication can be lifesaving, but medication can be tough on the body and mind, writes Naomi Arnold.

Psychiatric medication can be lifesaving, but medication can be tough on the body and mind, writes Naomi Arnold.

Psychiatric medication can be lifesaving. Ruby*, in her early 30s, says it saved her life. Diagnosed with anxiety, depression, obsessive compulsive disorder, and post-traumatic stress disorder, she had reached desperation point. She’s tried about a dozen on the anti-psychotic, anti-depressant, and anti-anxiety spectrum, and says they’re a tool you use in tandem with a host of other approaches to mental health.

“I have no doubt that I wouldn’t be here without them,” she says. “They saved my life.”

But medication can be tough on the body and mind – and it can be hard to get right. Caroline’s doctor prescribed her Prozac, which her psychologist supported. She was reassured – but once she started taking it she felt worse, with more extreme panic.

Her doctor doubled the dose, which she says was “a whole new type of hell”.

After six weeks she stopped taking it – which medical professionals agree is highly inadvisable – but in Caroline’s case the panic subsided. Later, she went on Mirtazapine, but the side effects were “extraordinary”. (Think weight gain, foggy thinking, memory loss, erratic periods, loss of libido and all the while the anxiety appeared to increase.) Again, she went against her doctor’s advice and stopped taking it.

“One week off that now and I’m almost back to normal,” she says.

She’s been told she’s one of a handful of people who react badly to the happy pills, but there is growing evidence that they’re not the only solution.

The Mental Health and Nutrition Research Group in the Psychology Department at the University of Canterbury has been investigating the link between micronutrients and mental health, and has stacked up a pile of research to demonstrate the benefits in children and adults, including earthquake victims.

Since 2010, when the group’s first study was published, UC clinical psychologist Julia Rucklidge has been a frequent face in the media, including presenting a TEDxChristchurch talk, The Surprisingly Dramatic Role of Nutrition in Mental Health, which had more than 600,000 views online.

One of the research group’s most recent publications, in the Journal of Child and Family Studies, investigated anxiety and stress in children following the Christchurch earthquakes. It found symptoms of  anxiety improved when they were supplemented with specialist formulations of micronutrients (see sidebar).

Neil McNaughton needs participants for his study and would like to hear from people either with anxiety or those who are ...

Neil McNaughton needs participants for his study and would like to hear from people either with anxiety or those who are curious about EEGs. Contact anxiety@otago.ac.nz.

“We saw such robust changes in the anxiety levels of the children in that study,” Rucklidge says. “Certainly the research is suggesting it’s a viable way forward, with virtually no side effects.”

The children’s sleep improved. They were less anxious about going to school. They seemed easier to reason with, and were better self-regulated.

“In our studies with kids, they often have multiple problems, not just anxiety. We see kids with encopresis [soiling themselves], bedwetting, a lot of irritability, oppositional behaviour, temper tantrums; and we have found with our research that those types of behaviours can also be well managed with the nutrients.

“Our experience of the nutrients over 10 years is that when it works – and I have to always be careful to say it doesn’t work for everyone – but when it does work we see a broad range of symptoms getting better.”

When 10-year-old Sam joined one of UC’s micronutrient studies, he wasn’t taking them for his tics and anxiety; he was taking them to see what effect they’d have on his ADHD. But a couple of weeks after he started on the specialist vitamins and minerals, his parents began to notice a difference.

“His anxiety had gone down and his tics had reduced, which go hand in hand,” his mother Karen says. “When he finished the programme, we took him off the micronutrients and we noticed within two days it all came back. He was quite anxious and had his head shake going on, clicking his fingers, doing all the things he used to do.”

They put him back on the pills. Six months on, Sam is still taking them, his parents buying the product direct from the distributor in Auckland when the study supply ran out.

“My message to other parents would be: don’t be scared to try them,” Karen says. “Even the smallest changes can make all the difference.”

The positive effect of nutrition on mental health is hardly a new idea. There are multiple studies showing the brain benefits of a better diet, but much of the discussion around junk and processed foods has been centred on obesity, not brain health.

Rucklidge believes that our current approach to mental health isn’t working very well. Many people don’t improve, even if they can access treatment, which would be a cause for outcry in any other field of medicine, she says.

“When it comes to mental health there’s this assumption that what we are actually offering, if everyone could get it, works. And that’s the wrong assumption,” she says.

“There’s this talk that we just need more resources. I would say we need to change what we’re doing, not just add more of the same.

“Even if you get the best treatment, many people don’t get better. That’s a hard thing for me to say, but the message has to get through.”

Pharmaceutical medication and psychotherapy certainly have their place, she says. But micronutrients have no side effects, and no street value. Why not try them before drugs, which can knock around already vulnerable people?

“We’re fine about all the people being on antidepressants, even though the long-term evidence for that approach is questionable and the side-effect profile can be concerning.”

But she says there’s difficulty getting buy-in from professionals. “There’s a lack of saying: ‘Why don’t you try some B vitamins first? Or change your diet?'”

She has lobbied for UC’s research to be considered in national care plans, but says there’s frustrating inertia.

Medsafe general manager Chris James says he’s aware of Rucklidge’s work and the organisation has approved the use of the micronutrient products in her  clinical trials only.

“Due to the inclusion of certain ingredients or levels of certain ingredients and the conditions for which the products are used in Prof Rucklidge’s work, these products are currently considered to be unapproved medicines,” he says.

But after the trials that UC runs, the families have often found such relief with the products that they want to keep using them. In a convoluted workaround, they’re able to buy the micronutrients with the permission of their GP or prescriber, which essentially means they are sold as an off-label medicine.

For the treatment to enter the mainstream and be prescribed as easily as Prozac, these micronutrients would need to become approved medications. Rucklidge would prefer they be approved as part of the Natural Health Products Bill and allowed to be sold as such.

But that’s difficult, as the vitamins and minerals in the products Rucklidge and her team use to achieve therapeutic results differ vastly from your standard supermarket multivitamin. They are sometimes present in high amounts many times over the recommended daily intake (RDI), and are therefore declared to be medicinal – but the cost and difficulty of registering them as medicine would put most natural health companies out of business.

The RDI is not an upper limit of safety, Rucklidge says. A handful of Brazil nuts can put you over the RDI for selenium, for example… “We have lots of evidence that there are very minimal safety issues, if any.”

The entire issue of what natural health products can be sold, and what they can claim, is currently before the Government as the Natural Health Products Bill, and Rucklidge has been lobbying against some of its wide-ranging restrictions.

The process for bringing a product into clinical care is extensive, and James says the Ministry of Health hasn’t received any application – including from Rucklidge – for consent to distribute the micronutrient products in New Zealand.

Rucklidge says that’s not her role, and she needs to stay at a distance from the products. It’s why she’s reluctant to mention brands.

“I am a researcher, not a salesperson or distributor of medicines,” she says.

“I find it frustrating as I need to stay impartial to do the research but also feel I have to advocate for people we have helped and for the vulnerable, people who are mentally ill.

“It would be nice if the Ministry recognised the benefits of the nutrients and actively worked with me and others involved to make access to them for New Zealanders simpler and affordable.”

She did apply to Pharmac to have them funded, but was turned down.

“I only did that because I am saddened when we help someone get better through our trials and they switch to medications because they can’t afford the nutrients. If the Ministry of Health really had the health of New Zealanders at heart, they would be proactive about it, they would find a way.”

James says the Ministry is considering the ingredients and conditions to determine their suitability under the upcoming Natural Health Products regime, and the work is ongoing.

In the meantime, Rucklidge finds herself sought out by thousands of people looking for help when everything else has failed. She replies with a form email, outlining the nature of her work and from where the micronutrients can be obtained.

Otherwise, her basic advice to improve mental health is, of course, to eat less processed food and more fruits and vegetables. But in the lab, she and her team don’t talk much about diet at all. Besides, basic lifestyle changes involving brisk walks in the fresh air and carrot sticks can seem impossible to someone in the clutch of depression or anxiety. It’s only when the dark moods lift that they become simple.

“We give nutrients to people and they get better,” she says.

“When people who aren’t eating very well start to feel better when getting additional nutrients in pill form, they start to make dietary changes. They don’t crave sugar and carbs as much, and we start to see improvements down the road.

“Once they see the simple effect of the pill and the impact it can have on their behaviour, a light bulb goes on.”

WHAT ARE MICRONUTRIENTS?

Micronutrients – as opposed to macronutrients carbohydrate, protein, and fats – are the regular vitamins and minerals that the body needs in trace amounts: B-complex vitamins, selenium, iodine, zinc, magnesium, iron, copper, etc. The World Health Organisation calls them “magic wands”, enabling the body to produce enzymes, hormones and other substances essential for proper growth and development.

We should be able to get enough from a healthy diet, but that’s in increasingly short supply these days because of an increased intake of processed foods, soil deficiencies, and certain farming practices.

GETTING THE MEDS RIGHT

Diagnosing and prescribing for psychiatric illness isn’t an exact science; people slip through the cracks and struggle to access help but they can also struggle with treatment itself.

However, there might soon be a better treatment answer than trial and error. University of Otago neuroscientist Neil McNaughton is developing one of the first methods to biologically test for any mental disorder, by measuring the brain response in a special test. The project, which has $1 million in funding from the Health Research Council, will run until the end of 2018, and investigates a particular brain rhythm that is reduced by anti-anxiety medication.

The study tests if the brain response is high in subjects with anxiety disorders. If it is successful, it should allow development of clinical tests that will be able to show who is more likely to have success with some types of medication and who is more likely to respond to others.

“This should help, particularly with the problem that – even when medication works – it can take weeks to have its full therapeutic effects, and so finding the right treatment can be a very long, drawn-out process,” he says.

The work should also lead to development of other biomarkers for mental illness, which means that multiple diagnoses at once will be possible.

* Names have been changed.

Anxiety New Zealand: anxiety.org.nz. Helpline 0800 ANXIETY (0800 269 4389)


 – Sunday Magazine

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