Re: found the article on Inositol doses

[Guest guest]

Inositol and OCD

By Frederick Penzel, Ph.D.

At the American Psychiatric Association (APA) conference in

1996, a paper was delivered on the treatment of Obsessive-Compulsive

Disorder with inositol, one of the B-vitamins. It seemed to indicate

that this might be a viable treatment for OCD. As someone who treats

OCD and related disorders, I am always on the lookout for new

approaches. I did some further research, and found that since the

early 1970s, a number of papers have been published on the use of

inositol in the treatment of OCD, depression, and anxiety. It seems

that inositol is converted by the body to two secondary

neurotransmitter chemicals that enhance the action of serotonin in the

brain. Serotonin, as we know, is a brain transmitter chemical that has

been implicated in OCD and related disorders. Not all of these studies

were conducted in the most scientific manner, but nevertheless, my

curiosity had been piqued.

After several discussions with one of the psychiatrists at

my clinic, we looked into its safety and possible interactions with

other drugs. It appeared that most people took in an average of about

1 gram of inositol each day in their diets. We discovered that apart

from some harmless digestive tract side effects, it appeared to be

quite tolerable, and would not interact harmfully with any of the

SSRIs our patients were taking for their OCD. At about the same time,

(September, 1996) a double-blind placebo-controlled study on the use

of high doses of inositol was published in the American Journal of

Psychiatry. Dr. Mendel Fux and colleagues in Israel conducted the

study. Although it was only a small study involving thirteen

individuals, inositol was found to have a significant effect upon the

symptoms of OCD. It was shown to work as well and as quickly as the

SSRIs Prozac and Luvox. The patients in this study had either not been

able to find relief via standard medications, or were unable to

tolerate medication side effects. Dosages in the study were gradually

built up to 18 grams per day.

The article proved to be the convincer for us. We had a

number of OCD patients, who were only getting partial relief from

prescription antidepressants, so we decided to suggest the possibility

of their trying inositol as an augmenting agent, in addition to what

they were already taking. I should mention here that our clinic is a

rather busy treatment center, and unfortunately, not really geared

toward conducting research, so we really didn't collect any data on

this. I know my learned colleagues will shake their heads at this, and

they would be right. In any case, we started to see some positive

results among some of those who tried it. In most cases, these results

ranged from at least mild to moderate relief of symptoms. A few

reported even more improvement. We have generally built up our

patients over a six-week period, starting with 1 teaspoon (2gms) twice

per day, and going as high as 3 teaspoons, three times per day. It

turned out that not everyone required the full 18 grams used in the

Fux study. One person was seen to improve on just 2 grams daily.

Since that time, we have also seen some positive results

child cases as well. I have also received some positive e-mails and

phone calls from O-C around the country who have heard of inositol,

and tried it. Although it was probably not as precise as we would have

liked, we based our children's doses on body weight, figuring roughly

that a 40-lb. child could tolerate a maximum dose of up to 6gms. of

inositol per day.

I do not believe that inositol is a 'miracle drug' for

everyone with OCD. There are no miracle treatments. I am sharing this

information with sufferers out there in hopes that it may help at

least some people who have not otherwise been able to get relief, or

who are too afraid of prescription medications to try anything. I also

decided to write about this because I felt that some people might hear

of this through some other sources, and try inositol without any

guidance.

**Please note the following: This advice is purely informational, and

not in any way meant to be a substitute for treatment by a licensed

physician. Do not try this, or anything else, without first consulting

your physician. If your M.D. has not heard about it, refer them to the

American Journal of Psychiatry article and let them decide.

Obviously, before you run out and try anything new, you

should always consult your physician. If your physician recommends

trying this, you might also want to mention the following information

to him or her:

1. It cannot be taken together with Lithium, as it seems to

block its action.

2. The chief side effects of inositol are gas and diarrhea.

Some people get this for the first

few days and then it clears up. Many of those

taking it never have this side effect, and some only get it

when they take more than a particular amount.

3. I have heard reports that caffeine lowers inositol

levels in the body, so if you are a

heavy coffee drinker, you might consider cutting

down or eliminating this from your diet. Actually,

stimulants such as caffeine can sometimes

contribute to anxiety, jitteriness, etc.

4. It should be purchased in powdered form, and taken

dissolved in water or fruit juice. It

has a sweet taste, and is chemically related to

sugar. If it is allowed to stand for about 10 minutes after

mixing it, it seems to dissolve better. Vigorous

mixing for a few minutes also helps. If it still doesn't

dissolve well (not all brands do), stir it up and

drink it quickly before it settles. The use of powder is

recommended, as the larger doses required could

require taking as many as 36, 500 mg. capsules per

day.

5. Inositol is a water-soluble vitamin, so although the doses

appear to be large, it will not

build up to toxic levels in the body. Whatever

the body doesn't use is excreted. The average person

normally takes in about 1 gram of inositol each

day via the food they eat. There are no reports of any

harm associated with the long-term use of

inositol. Some of our patients have been taking it as long as

eight years now, with no problems.

6. It can be built up according to the following schedule (1

teaspoon=2 grams, and be

sure to use a measuring spoon) for an adult:

Week 1 - 1 teaspoon/2x per day

Week 2 - 1 teaspoon/3x per day

Week 3 - 1.5 teaspoons/3x per day

Week 4 - 2 teaspoons/3x per day

Week 5 - 2.5 teaspoons/3x per day

Week 6 - 3 teaspoons/3x per day

A child can be built up to 3 teaspoons per day over the same

six-week period. Dosages for adolescents can be adjusted according to

weight. In either case, it is best to allow side effects to be the

guide. If they begin to occur, it is not considered wise to increase

the dosage unless they subside.

Once a person has reached either the maximum dosage, or the

greatest amount they are able to tolerate, it is best to try staying

six weeks at that level to see if there is any noticeable improvement.

If there is none by the end of that time, it should probably be

discontinued. As with any treatment, those who are absolutely positive

that it will help are only setting themselves up, and may wind up more

than disappointed. Everything works for someone, but nothing works for

everyone.

One further note. I know personally of one case where an

adolescent with trichotillomania was administered a combination of

inositol and a substance known as 5-HTP, which is a breakdown product

of the amino acid L-Tryptophan. The body manufactures serotonin from

5-HTP, and serotonin is believed to be one of the brain transmitter

chemicals implicated in trichotillomania. Taking this is believed to

raise serotonin levels in the brain. This adolescent got partial

results with inositol, and seemed to get a complete remission of the

urge to pull with the addition of 100 mg. of 5-HTP daily. 5-HTP can

cause drowsiness, and is usually taken at bedtime. It should never be

taken with any prescription antidepressant (such as an SSRI) or herbal

products such as St. 's Wort, as it can cause a very serious

condition called serotonergic syndrome.

Again, none of the above is meant to be a substitute for

expert medical advice. As with inositol, 5-HTP should not be taken

without the supervision of a licensed physician. I find reports such

as this rather interesting. and further study is clearly needed. It

may have implications for the future treatment of trich.

*** As an interesting side note, a study was published (Seedat et al,

2001) since this article was written, in which three women with hair

pulling and compulsive skin picking were treated with inositol. All

three were seen to improve and this improvement was seen to continue

through a 16-week follow-up period. Hopefully, there will be further

studies on the usefulness of this compound.

If you would like to read more about what Dr. Penzel has to say about

OCD, you may be interested in his self-help book,

" Obsessive-Compulsive Disorders: A Complete Guide To Getting Well And

Staying Well, " (Oxford University Press, 2000). You can find out more

about it at www.ocdbook.com.