Major review asks which supplements really aid mental health

[panic_down_under]

Controversy surrounds the inclusion of nutritional supplements in mental health treatments, with much research proving inconclusive. A major new review now explains which supplements have shown the most promise for specific mental health conditions.

...However, they note, a few supplements did help improve specific symptoms of particular disorders "under certain conditions" and when the person took them alongside other treatments.
The meta-analyses that the researchers assessed indicated that omega-3 supplements could help relieve symptoms of major depression in people who also take antidepressants.

...For mood disorders and schizophrenia, N-acetylcysteine — an amino acid — seemed to help when individuals took it alongside their regular treatments.

Various dosages of folate-based supplements seemed to help with managing symptoms of depression and schizophrenia — though folic acid did not have this effect.

...Yet when it comes to vitamins and minerals, the researchers found no compelling evidence to suggest that these could help manage any symptoms related to mental health.

More: Major review asks which supplements really aid mental health

Study - full text: The efficacy and safety of nutrient supplements in the treatment of mental disorders

Magnesium supplements should also be considered, imho, as there is some evidence it has a positive impact on anxiety and depression, plus it may help ease some antidepressant and antipsychotic side-effects such as restless legs.

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Of the two main fatty acids in Omega-3/fish oil, eicosapentaenoic acid (EPA) seems to be more important than docosahexaenoic acid (DHA) for easing anxiety and depression so if the cost is about the same choose the brand with the highest EPA-DHA ratio (Liao Y, 2019; Mocking RJ, 2016; Grosso G, 2014; Samieri C, 2012; Sublette ME, 2011; Martins JG, 2009).

Caution: Both fish oil and serotonergic antidepressants are mild anticoagulants which can be beneficial as they may reduce heart attack and ischaemic stroke risk (but may slightly increase that of the much less common hemorrhagic stroke), however, there is a risk of bleeding when the supplement is taken at high doses together with SSRIs/SNRIs/some TCAs. Fish oil at the recommended dose is usually safe, but lower the dose if you begin to bruise more easily, or develop nose, or gum bleeding. Also avoid taking aspirin and other NSAID painkillers such as ibuprofen and naproxen, which also 'thin' the blood. Paracetamol, aka acetaminophen, is the preferred painkiller.

N-Acetyl-Cysteine (NAC) is generally a safe supplement with few side-effects. It is mostly used medically to protect the liver in cases of paracetamol, aka acetaminophen, overdose and has other medical uses. NAC has been shown to be particularly effective in reducing OCD intrusive and compulsive thought patterns and also in boosting the effectiveness of antidepressants for OCD and other OCD spectrum disorders [1].

Doses of 1,800-3,000mg/day taken in 3 divided doses seems to work (start with one dose per day of around 500-600mg and increase by the same amount every 2-3 days to avoid triggering diarrhoea). NAC is best taken on an empty stomach about an hour before meals.

Caution: a study [2] found NAC (and Vitamin E) may increase the risk of lung cancer in smokers, or those with some specific lung diseases (note, the study found it doesn't cause lung cancer, only maybe reduces the ability of the immune system to detect and destroy existing cancerous cells). This finding has been the subject of much debate and considerable scepticism because there are many other studies showing NAC protects against lung cancer so it is probably not the final word on the subject. FWIW, I'm a lung cancer survivor and have take NAC for over 12 years because it is the best thing I've found for reducing fluid build up in my remaining lung. As of 6 months ago I was cancer free.

Seek the advice of your GP, or pharmacist before taking NAC. While NAC can be beneficial for asthmatics with fluid build up in lungs, it may cause shortness of breath in some, so caution is needed if you have asthma. It is contraindicated for those taking nitroglycerin, vitamin K and some blood pressure meds.

[1]
Couto JP, Moreira R. (2018)
Oral N-acetylcysteine in the treatment of obsessive-compulsive disorder: A systematic review of the clinical evidence.
Prog Neuropsychopharmacol Biol Psychiatry. Aug 30;86:245-254 (Abstract)

di Michele F, Siracusano A, Talamo A, Niolu C. (2018)
N-Acetyl Cysteine and Vitamin D Supplementation in Treatment Resistant Obsessive-compulsive Disorder Patients: A General Review.
Curr Pharm Des. 24(17):1832-1838 (Abstract)

Ghanizadeh A1,2, Mohammadi MR3,4, Bahraini S, etal. (2017)
Efficacy of N-Acetylcysteine Augmentation on Obsessive Compulsive Disorder: A Multicenter Randomized Double Blind Placebo Controlled Clinical Trial.
Iran J Psychiatry. Apr;12(2):134-141 (Abstract | Full text)

Oliver G, Dean O, Camfield D4, Blair-West S, et al (2015)
N-acetyl cysteine in the treatment of obsessive compulsive and related disorders: a systematic review.
Clin Psychopharmacol Neurosci. Apr 30;13(1):12-24 (Abstract | Full text - PDF)

[2]
Sayin VI1, Ibrahim MX, Larsson E, et al. (2014)
Antioxidants accelerate lung cancer progression in mice.
Sci Transl Med. 2014 Jan 29;6(221):221ra15 (Abstract | Full text - PDF)

[Dying_Swan]

Thank you for this. I saw you mention magnesium supplements on another thread about myoclonic jerks. Do you know what sort of dose might help?

[panic_down_under]

Do you know what sort of dose might help?

Start with the equivalent of 150mg elemental magnesium - magnesium comes in various forms such as magnesium chloride/citrate/*hydroxide/*oxide/*sulfate, etc, so the tablet size vary, but the packaging should state the element equivalent and increase as necessary. Fwiw, I take 1 x 150mg magnesium tablet twice a day with each tablet containing 930mg magnesium citrate.

* these are either poorly absorbed, or strong laxatives so best avoided

Note: magnesium can interact with some antibiotics, bisphosphonates for osteoporosis, calcium channel blockers for blood pressure, diuretics and muscle relaxants, so seek advice from your pharmacist if taking any of these meds. In some cases magnesium supplements can still be taken a few hours before, or after the med.

The U.S. NiH has a useful summary and dose suggestions in its magnesium fact sheet.

[Dying_Swan]

Thank you for your advice. I will look into it. Still twitching a lot which I can only think is the meds, so maybe magnesium will help.

[MyNameIsTerry]

Here are some useful threads I keep on my User Notes about magnesium:

Some useful magensium threads for you:

http://www.nomorepanic.co.uk/showthr...ight=magnesium
http://www.nomorepanic.co.uk/showthr...ight=magnesium
http://www.nomorepanic.co.uk/showthr...ight=magnesium
http://www.nomorepanic.co.uk/showthr...ight=magnesium
http://www.nomorepanic.co.uk/showthr...38#post1452038

Ian, in the UK there doesn't appear to be legislation ensuring supplement manufacturers detail the elemental value. I have long suspected this is why so many people try it to find it does nothing when they don't realise just how little they are getting.

I would avoid oxide, it's poorly absorbed as are all salt forms, but when it hits the oxygen in your stomach it changes form to what we commonly know as Milk of Magnesia. The benefits of this form are more for the GI. It also causes bowel troubles and you can't go higher in dosage as with other forms due to this.

Citrate being an amino form, a chelated magnesium, is better and it's one of the better absorbed forms of magnesium. There are two forms of that mean the elemental value can differ but it's easy to work out if you look at the links (provided for others as I'm sure you know this stuff).

Also, I have found UK manufacturers deliberately mislead with their labels. For instance, some will say 1000mg of magnesium citrate on the front and say 1000mg elemental magnesium on the back. That's nonsense as it defies science. The whole point being that the 1000mg is made up of citrate and separate magnesium added together hence they combine to make that value. And the magnesium levels are often much lower.

Then there are the types themselves, the added elements like citrate. Each does something different so you may be looking for a specific type because of your symptoms. That can also bring in other factors such as with the chelated taurine version where the body ends up sending a lot of taurine elsewhere anyway based on need.

So, it's a bit of suck it and see. But know the rules about them or the manufacturers can con you and you may miss out thinking magnesium doesn't work for you.

[MyNameIsTerry]

I'll add another link to some useful Omega 3 discussions we've had on here as our vitamin queen, Marie (SAD_No_More), who has moved on by the looks of it did a lot of research into this. Her GP admitted he wouldn't even test his patients for vitamin D deficiency anymore because he said they would all be deficient due to where they lived in Canada.

With Omega 3 though it is about unopposed EPA. This makes finding supplements hard because they tend to be mixed and have similar levels of EPA and DHA.

But I have found even 105mg of unopposed EPA helped me with mood swings caused by meds. I used to have endless swings and within a month of taking this, and having some intensification of anxiety as a fallout of this, my swings stopped. About 6-7 months later I stopped taking it (I got lazy over Christmas) and back came the swings. This wasn't an anxiety thing for me because the swings started with a med and I wasn't even caring about not taking the supplement when it started failing. The old patterns came straight back even though I was fine before that even after I had stopped taking it.

I had previously looked into some meta-studies about it to find results were inconclusive but since some studies found results decided it was worth a try. It's a cheap solution, provided you stay away from the expensive brands (they may have better bioavailability though), and I can remember my mum force feeding me a spoonful of nasty tasting cod liver oil every night before bed as a child!

I would also say beware any label saying "high strength". I lot of them really aren't high strength. I've found this applies more the capsules and liquid forms are more likely to be high strength. Otherwise you need to take a fair few capsules to match the liquid forms.

[panic_down_under]

Also, I have found UK manufacturers deliberately mislead with their labels.

The supplements industry should really be required to call itself the Buyer Beware industry to abide by truth in advertising laws. There's very little real oversight of it. The only time regulators act is when the horse has long bolted and even then action is mostly just a soft slap on the wrist.