Copper Mineral Toxicity : Irritability and Anger

Citation preview

PSYCHIATRY REDEFINED

PERSPECTIVES IN FUNCTIONAL PSYCHIATRY

Irritability and Anger The Role of Copper Toxicity

JAMES GREENBLATT, MD

Contents 01

INTRODUCTION

02

THE CASE OF THE “TROUBLED” TODDLER

04

GOING BEYOND POLYPHARMACOLOGY

05

A FUNCTIONAL MEDICINE SILVER LINING

07

THE IMPACT OF NUTRITIONAL DEFICIENCIES

08

CONCLUSION

09

ABOUT THE AUTHOR

10

REFERENCES psychiatryredefined.org

INTRODUCTION

A Functional Medicine Approach to Irritability and Anger We have all experienced irritability. Seemingly minor events can provoke frustration, anger, and even rage. Toddlers are known for their temper tantrums, but when verbal or behavioral outbursts in older children interfere with school or relationships, a mental health evaluation often follows. Irritability and anger are rarely understood as discrete symptoms, but are rather viewed as symptoms of another underlying diagnosis. Patients seeking a psychiatrist’s help for presentations of irritability, anger, or even aggression, are commonly treated with a blanket approach for larger, more encompassing diagnoses such as depression, bipolar disorder, and ADHD. These individuals are frequently prescribed a surplus of medications, resulting in an endless cycle of trial-and-error polypharmacy that lacks a clinical appreciation of the underlying causes of patient symptomatology. psychiatryredefined.org

I have utilized a Functional Medicine approach to treat irritability and anger disorders for over three decades with significant success and symptom relief. Functional Medicine takes into consideration the numerous clinical, biochemical, nutritional, and environmetal influences that contribute to changes in mood and behavior. Functional Medicine has allowed patients to find relief from damaging behaviors, strained relationships, failing jobs, and the many inevitable consequences endured by those who experience disruptive mood and behavior disorders. The case below illustrates a Functional Medicine approach to the treatment of irritability and aggression in a young child.

1

CHAPTER 1

The Case of the “Troubled” Toddler By the time six-year-old Ethan had entered first grade, his parents had already labeled him a “handful.” As a toddler, Ethan threw tantrums constantly. The smallest frustration caused him to hurl objects at his parents and scream for hours when upset. In addition to his irritability, his mother noticed that her son also had difficulty concentrating, but chalked up both his tantrums and distractibility to “typical” boys-will-be-boys behavior. But when his first-grade teacher called home one September afternoon to report that Ethan had hit another student in the face after a minor dispute over a pencil, his mother immediately scheduled an appointment with their pediatrician. The pediatrician confirmed that Ethan displayed the requisite symptoms for a clinical diagnosis of ADHD. He was unable to concentrate on tasks for more than a few minutes and was extremely disorganized. His irritability and rage, in the physician’s estimation, was simply another symptom of the impulsivity that often manifests in patients with ADHD. Ethan’s pediatrician proceeded by prescribing him Adderall XR, an extended-release stimulant commonly used to treat ADHD in children. His mother initially expressed reluctance, as she did not want to “medicate” her first grader, but ultimately decided to trust the doctor’s recommendations. psychiatryredefined.org

2

If the medication would help her son exercise more self-control and perform better in school, it was surely worth a try. After two weeks on Adderall, Ethan seemed even more irritable and out-ofcontrol than before.

One evening, Ethan scaled a dining room hutch and unintentionally broke a set of dishes. In fact, he burst into destructive rages with even greater frequency on his medication, which began to create a rift among his parents and other siblings. Returning to the pediatrician after a failed attempt with the first medication, Ethan was prescribed a different medication called Concerta. Without undergoing any additional testing, the pediatrician decided that Ethan’s ADHD might be more responsive to an alternative stimulant. However, shortly before Thanksgiving break, Ethan’s teacher called home once again to inform his mother that Ethan had hit another student on the playground. With no signs of improvement in sight, Ethan’s mother decided to make an appointment with a child psychiatrist who specialized in childhood behavioral disorders.

psychiatryredefined.org

The psychiatrist explained that he had seen cases similar to Ethan’s before: the first-grader suffered from ADHD, in addition to the new diagnosis of Disruptive Mood Dysregulation Disorder (DMDD), which was only recognized as a psychiatric illness in the DSM-5 in 2013. Ethan’s psychiatrist was not surprised that his pediatrician failed to identify a diagnosis of DMDD because it was relatively new. This time around, Ethan was prescribed new medications to reflect the psychiatrist’s updated diagnosis: Intuniv, often used as adjunctive therapy for the treatment of ADHD, and Risperdal, an antipsychotic medication traditionally used in the treatment of schizophrenia and bipolar disorder, but now approved for the treatment of irritability associated with autism spectrum disorders. At age six, Ethan was on multiple medications, with little to no improvement in his mood and behavior, and leaving his parents without a clear understanding of the root causes contributing to his diagnoses. Needless to say, Ethan’s problems continued unabated. In mid-January, the principal of Ethan’s elementary school called to schedule an urgent meeting with his parents. The principal explained to Ethan’s parents that based on their son’s repeated counts of inappropriate behavior, their son may require a school better equipped to deal with “problematic” students.

3

CHAPTER 2

Going Beyond Polypharmacology The reason polypharmaceutical practices have become so common is that most psychiatrists simply use subjective lists of behavior to identify diagnosis. Diagnoses are based on data drawn from broad population studies, rather than an individualized approach, taking both nutritional and environmental factors into account, and to explain unique manifestations of who we are. Psychiatrists frequently over-prescribe medications, not due to a lack of medical professionalism, but rather a failure to identify the idiosyncratic and individual etiologies that produce mental health issues. Science is beginning to understand how symptoms associated with mental illness differ based on biochemical and neural functions that are specific to each disorder and each individual.

psychiatryredefined.org

For example, Eshel and Leibenluft (2020) suggest that the brain mechanisms mediating irritability in DMDD, ADHD, and anxiety disorders, have many underlying differences to the mechanisms mediating irritability in childhood bipolar disorder. This is an important distinction to make, because failure to prescribe the correct medications, and to treat root causes of psychiatric disorders, such as micronutrient imbalances, may worsen outcomes for patients.

We can do better. And we must do better for the thousands of children like Ethan. 4

CHAPTER 3

A Functional Medicine Silver Lining Later that spring, after months of failed attempts, Ethan became my patient. After carefully reviewing his records and current medications, it became clear to me that neither his pediatrician nor psychiatrist had run any testing to rule out possible medical causes to his behaviors. I conducted my usual battery of laboratory tests to assess for nutritional deficiencies, food allergies, and environmental toxins. One diagnostic I use is a hair test to identify levels of trace mineral imbalances. Ethan’s results revealed that he had elevated copper levels. Most of us are aware of the dangers of lead, particularly lead exposure among children under the age of six. In addition to somatic illness such as hearing loss and seizures, lead exposure can cause significant developmental delays, lifelong learning difficulties, ADHD and irritability in children. The Flint Water Crisis, which began in 2014 after the state government of Michigan switched the municipality’s water supply from the Detroit River to the Flint River, brought

psychiatryredefined.org

lead exposure back into public view in an especially forceful way. Lead became prevalent in the city’s drinking water because the supply system from the Flint River relied on deteriorated and corroded pipes (Clark 2018). The renewed media attention that the Flint Water Crisis brought to the long-term dangers of childhood lead exposure was an important reminder of the environmental factors that play a critical role in mental health. At the same time, health officials and clinicians often focus myopically on lead, paying virtually no attention to other metals and minerals that pose acute threats to public health. We are less aware, for instance, of the impact copper has on our health. While it has long been recognized that increased copper in drinking water is dangerous to pregnant women and contributes to gastrointestinal problems (“Copper in Drinking Water,” 2000), increased copper levels in the body have been shown to manifest as ADHDlike symptoms and irritability in children.

5

A 2016 study that sampled the water quality in over three hundred public schools in the state of Massachusetts showed that only seventy-three of the samples came back negative for elevated levels of either copper or lead. Children attend schools on a weekly basis and are encouraged to drink water to stay hydrated throughout the day, unaware of the potential dangers of doing so. Similar to the problem in Flint, Michigan, widespread toxic metal exposure in the Massachusetts Public School system will ultimately require the implementation of largescale and systematic policy change to reduce exposure risk to our most vulnerable populations. Regardless of the origin of exposure, no child is immune to the harmful effects of toxic metals.

With risk of exposure being so high and a continual rise in rates of children displaying irritable and unfocused behaviors, it is critical that trace mineral testing begins to be employed as part of the diagnostic testing model for ADHD, and mental illness more broadly. We know that copper is an important mineral for certain enzymes—monoamine oxidase, dopamine-beta-hydroxylase, and tyrosine hydroxylase, namely—instrumental to the production of dopamine, the brain’s “pleasure” neurotransmitter, which in turn impacts the neurotransmitter norepinephrine, the organic chemical responsible for, among other things, our “fight-or-flight” response (Greenblatt and Lee, 2019).

psychiatryredefined.org

Discovering that Ethan’s copper levels were on the very high end of the distribution curve enabled us to make an medically-informed deduction: his irritability—his lashing out at fellow classmates and outbursts—and clinical diagnoses of ADHD and DMDD may be related to excess copper.

6

CHAPTER 4

The Impact of Nutritional Deficiencies From a clinical perspective, Ethan suffered from a dopamine/norepinephrine imbalance caused by elevated copper levels. For such patients, Adderall, which increases both the activity and production of the neurotransmitters of dopamine and norepinephrine, actually worsened his psychiatric disorder. Prescribing stimulants such as Ritalin or Adderall for patients experiencing copper neurotoxicity is the equivalent of pouring water on a grease fire! The natural pathways of elevated copper levels consequently produce lower zinc levels, and a higher copper-to-zinc ratio. Over the course of my thirty-five years of clinical practice, however, I have successfully treated childhood irritability, often associated with an ADHD diagnosis, through zinc supplementation for patients with elevated copper levels. In my book, “Finally Focused: The Breakthrough Natural Treatment Plan psychiatryredefined.org

for ADHD,” I discuss a wide range of nutritional deficiencies and imbalances that contribute to, and oftentimes, worsen symptoms of ADHD. These could be anything from magnesium deficiencies, lithium deficiencies, or even food allergies and sensitivities. Every patient presents unique differences in their biochemical makeup, levels of environmental exposure, diet, and social influences, and should be tested and treated as such. The more we can tailor our diagnoses and treatment approaches to the patient as an individual, the more likely we are to identify the underlying causes of their symptoms. In attempts to normalize Ethan’s elevated copper levels, we prescribed 15 mg of zinc daily and started to taper his antipsychotic medications. Over a period of three months, Ethan showed a significant improvement: not only did his outbursts subside, but he was better able to concentrate on everyday tasks. We gradually increased his dosage of zinc, and eventually tapered him off his other medications. By April, Ethan’s teacher was astounded by the progress that he had made, as his behavior now fell within the range of his classmates. When I last visited with Ethan and his mother, he was entering second grade free from the irritability and anger issues that had previously plagued him and his family. Like the hundreds of other children treated for irritability and aggression with a Functional Medicine approach, Ethan found his silver lining.

7

Conclusion Cases like Ethan’s reveal just how profound an impact a Functional Medicine approach can have for patients suffering from irritability and anger. Far too many patients seeking treatment for mental illness, are placed on multiple medications, often prior to identifying a causal explanation for why symptoms are manifesting in the first place. The relationship between copper and ADHD is one example of how Functional Psychiatry can be used as a powerful and effective tool for treating mental illness. And it does not stop at irritability and anger. This approach, when utilized successfully, can also provide relief to patients suffering from depression and anxiety. The more we understand about our patients’ unique biological and genetic profiles, the better we will serve them as clinicians on their journey towards sustained mental health and wellbeing.

As an integrative psychiatrist utilizing Functional Medicine, I may prescribe medications when appropriate. My goal is always to relieve suffering and improve clinical outcomes. The transformative specialty of Functional Psychiatry provides a true model for integrating clinical symptoms with genetic vulnerabilities, nutritional deficiencies, underlying metabolic abnormalities, and lifestyle. I describe my approach as functional, precisely because it examines these factors in addressing our patients’ mental health issues, discovering long-term solutions rather than short-term fixes.

Patients are not merely a cluster of symptoms. Our patients are too complex for generalizable diagnostic classifications. Attaching a label encourages medical interventions that may not only fail to relieve patient suffering, but, in some cases, worsen their condition.

psychiatryredefined.org

8

Are you ready to move beyond symptom management, and help your patients find a new path to recovery?

Click here to watch our FREE webinar on Functional Medicine for ADHD.

About the Author JAMES GREENBLATT, MD

A pioneer in the field of Integrative Medicine, James M. Greenblatt, MD, has treated patients since 1988. After receiving his medical degree and completing psychiatry residency at George Washington University, Dr. Greenblatt completed a fellowship in child and adolescent psychiatry at Johns Hopkins Medical School. Dr. Greenblatt currently serves as the Chief Medical Officer and Vice President of Medical Services at Walden Behavioral Care in Waltham, MA, and as an Assistant Clinical Professor of Psychiatry at Tufts University School of Medicine and Dartmouth College Geisel School of Medicine. For the last three decades, Dr. Greenblatt has devoted his career to educating his colleagues, clinicians, and patients on the profound effects Functional and Integrative Medicine can have on mental wellness, and Mow to employ balanced, integrative strategies in the treatment of psychiatric disorders.

psychiatryredefined.org

In April of 2017, Dr. Greenblatt was inducted into the Orthomolecular Medicine Hall of Fame by the International Society of Orthomolecular Medicine, which has recognized significant contributors to science and medicine who operate from the perspective of biochemical individuality and nutritionbased therapies. Dr. Greenblatt’s knowledge in the areas of biology, genetics, psychology, and nutrition as they interact in the treatment of mental illness has made him a highly sought-after speaker at national and international conferences and workshops. He currently offers online courses for professionals, as well as specialized fellowship programs in Integrative and Functional Psychiatry, through his educational platform, Psychiatry Redefined. Dr. Greenblatt has authored seven books on depression, eating disorders, ADHD, suicide prevention, and more.

9

REFERENCES

Clark, Anna. The Poisoned City: Flint’s Water and the American Urban Tragedy. Metropolitan Books, 2018. Eck, Paul C. and Larry Wilson. Copper Toxicity. Eck Institute of Applied Nutrition and Bioenergetics, 1989. Eshel, Neir and Ellen Leibenluft. “New Frontiers in Irritability Research—From Cradle to Grave and Bench to Beside.” The Journal of the American Medical Association, 2019. Greenblatt, James and Winnie Lee. Integrative Medicine for Depression: A Breakthrough Treatment Plant That Eliminates Depression Naturally. Friesen Press, 2019. Greenblatt J, Gottlieb B. Finally Focused: the Breakthrough Natural Treatment Plan for ADHD That Restores Attention, Minimizes Hyperactivity, and Helps Eliminate Drug Side Effects, 2017. Mayo Clinic. “Lead Poisoning” Mojtabai R, Olfson M. National Trends in Psychotropic Medication Polypharmacy in Office-Based Psychiatry. Archives of General Psychiatry. 67 (1): 26, 2010. National Research Council Committee on Copper in Drinking Water. “Health Effects of Excess Copper.” Copper in Drinking Water. Washington DC National Academies Press, 2000. Rocheleau M. “High lead levels found in water at hundreds of schools” The Boston Globe Swardfager, W. et al. “Potential Roles of Zinc in the Pathophysiology and Treatment of Major Depressive Disorders.” Neuroscience and Behavioral Reviews. Vol 37: Number 5, June 2013, pg. 911-929.

Psychiatry Redefined is an educational platform dedicated to the personalized, evidence-based treatment of mental illness. We provide comprehensive Integrative Medicine and Functional Psychiatry training to help clinicians treat the root cause of psychiatric disorders, presenting patients with a new model of recovery.

Together we can redefine mental wellness. psychiatryredefined.org

10