Nutritional Lithium mineral Deficiency : Irritability and Anger ( Perspectives in Functional Psychiatry )

Citation preview

PSYCHIATRY REDEFINED

PERSPECTIVES IN FUNCTIONAL PSYCHIATRY

Irritability and Anger A Lithium Deficiency Disorder?

JAMES GREENBLATT, MD

INTRODUCTION

A Functional Medicine Approach to Aggression & Irritability Our current psychiatric model offers little guidance in understanding and treating aggression and irritability in patients. Aggressive and irritable tendencies are often diagnosed as symptoms of a larger, more encompassing illnesses such as depression and bipolar disorder, and are frequently neglected as mental illnesses in their own right. Irritability has received little attention in psychiatry as there is no standardized protocol or biological assessment for treatment. Regardless of the primary psychiatric diagnosis, chronic aggression and irritable behavior is prognostic of longer and more damaging disorders, resulting in poorer patient outcomes. A Functional Medicine approach takes the biological basis of aggression into consideration, which leads to a more comprehensive understanding of how neurotransmitter function, nutrient metabolism, and brain structure, all contribute to unique manifestations of aggression. By understanding the physiological contributors to aggression, physicians and researchers can better understand aggressive behaviors on an individual level and provide patients personalized treatment options. psychiatryredefined.org

21

CHAPTER 1

Understanding Aggression & Irritability Aggression is a term used to describe a range of behaviors that result in physical and emotional harm to oneself, others, or objects in the environment. It is a problematic public health concern that can have a destructive impact on individuals, families, and communities. Aggression and aggressive tendencies are most commonly believed to be a result of environmental and psychosocial factors, including genetic influences, traumatic life experiences, and childhood violence.

CHAPTER 2

A Case of Road Rage

While aggression presents as extreme behavior, irritability manifests more subtly. Irritability can loosely be defined as a state of hypersensitivity and reactivity, resulting in excessive and easily provoked anger, annoyance, or impatience.

Allen did not come in for treatment willingly. I had been treating Allen’s stepson for ADHD when his live-in partner, Samantha, approached me with her concerns about Allen. She described the following incident to explain Allen’s typical behavior:

Viewed as a milder form of aggression, irritability often produces an array of personal consequences, including academic problems, poverty, psychopathology, and suicidality. Considered a low-frequency behavior, there is currently no reliable marker, measure, or test, to diagnose irritability—similar to its kindred diagnosis of aggression.

“We were driving to my parent’s house for dinner one Sunday when another driver cut in front of us. Allen began to curse and honk his horn excessively until the driver pulled over, allowing Allen to pass. Instead of driving away, Allen’s anger continued to escalate until he got out of his truck, grabbed a crowbar from the trunk and started charging towards the other driver. The driver sped off and fortunately nobody was hurt, but at that point I knew that Allen needed help.”

In the following, we will examine a case that demonstrates just how disruptive “lowfrequency” manifestations of irritability can be for patients and those around them.

psychiatryredefined.org

Allen did not believe he had an anger problem. He had been on several antidepressant medications in the past to control his mood, including Zoloft and Prozac.

2

While these medications seemed to be effective in helping Allen control his depression, his uncontrolled levels of irritability remained.

close with his family. At the time, however, Allen had been sober for more than ten years and functioned in a high-level sales job.

After several repeated attempts, Samantha finally made Allen seek help. When he arrived at my office for his scheduled appointment, he proceeded to scream at my administrative assistant for “making” him fill out “so many stupid” forms. To make matters worse, I was running fifteen minutes behind schedule, which only intensified his anger.

After Allen settled down and I was able to ask more detailed questions about his childhood, medical history, family history and past attempts of therapy and medications, I realized that he was caught in a mental health system that really didn’t know how to treat his problem.

Allen entered my office in the same belligerent state; he glared at me and shouted several expletives seemingly directed at no one in particular. Eventually, he was able to discuss his ongoing issues with anger but remained hostile throughout our session. During my initial visit with Allen, I learned that he had lost several jobs earlier in his life and had a history of alcoholism, depression, and irritability. When asked about his family, he reported that his father and many uncles were alcoholics. He had left his childhood home at the age of eighteen and was not

Allen went to therapy as a teenager and had been on and off antidepressants since the age of 16. When the irritability persisted even after therapy and multiple medications, he found success in Alcoholics Anonymous (AA), which helped him quit drinking, but didn’t address his underlying irritability and anger. Allen had never hurt anyone, but he had experienced ‘road rage’ for years. Incidents, such as one his partner Samantha described, had been a consistent feature of Allen’s life. I recommended he take 5mg of nutritional lithium daily for a month, and we scheduled a follow-up session.

Allen had never hurt anyone, but he had experienced road rage for years.

psychiatryredefined.org psychiatryredefined.org

43

When I met Allen for the second time approximately one month after our initial meeting, he came to the office with Samantha. Allen was calm and inquisitive about his lab tests. He reported no side effects on the 5 mg of lithium and described a week without any episodes of road rage. His wife thought Allen was less irritable at home and had, as an example, tolerated a long wait in a restaurant where they had a reservation—typically, she explained, these were the kinds of incidents that sent him “over the edge.” During our second session, we mostly discussed laboratory tests for low levels of Vitamin D, and I prescribed 5,000 IU of Vitamin D and asked Allen to increase his nutritional lithium to 10 mg twice a day. When Allen returned for his second follow-up visit, after three months on the 10 mg of lithium and Vitamin D, he walked towards me, smiled and shook my hand. The gratitude in his eyes was apparent. As we completed our session, he expressed his remorse over how his irritability and angry outbursts impacted his family and others.

“Thank you,” he said. “I’m feeling so much better. I feel bad for my family. I didn’t realize how irritable I felt, and I can’t believe the difference.”

psychiatryredefined.org

CHAPTER 3

Lithium: It’s All Elemental Flashback 13.8 billion years to the Big Bang. Only a few elements were present when the universe was formed: hydrogen, helium, beryllium, and lithium. Lithium is a part of nature, radiating through sunlight, mineralized in rocks and soil, and flowing through the oceans. The mineral is present in our cell phones, electric cars, and fireworks on the Fourth of July. Lithium can also be found in every organ and tissue of the human body and plays a particularly crucial role in overall brain health. It is even present in trace amounts in the food we eat and the water we drink—it is, indeed, a critical nutrient for many aspects of human physiology.

4

Lithium received a popular introduction for its mood-boosting properties in 1929 when soft drink entrepreneur, Charles Leiper Grigg launched his lithiated lemon-lime soda, touted for its ability to “take the ouch out of grouch.” We now know this carbonated beverage as “7-Up,” whose name was likely coined as a nod to the atomic weight of Lithium (6.9) and its power to lift “up” spirits. Lithium has since been removed from said soft drink, but Grigg’s initial perception rings true: lithium has the ability to substantially calm those experiencing anger or irritability.

In fact, lithium has the ability to transform lives and heal the brain.

CHAPTER 4

Nutritional Lithium While lithium has been widely prescribed and researched for its demonstrated mood stabilizing effects, it still remains underutilized and misunderstood in the field of medicine. It is important to understand that nutritional lithium is not a synthetic chemical or phamaceutical drug. The supplement, lithium orotate, must be distinguished from prescription doses of lithium, as much smaller quantities of lithium are present in the supplement. Lithium is an alkali metal that is naturally found in the diet, mainly in plant-based sources including grains and vegetables, which is precisely why the supplement is called “nutritional lithium.” When used as a nutritional supplement, I have found that the side effects of lithium are non-existent. Nutritional lithium is a safe, integrative, and effective treatment for psychiatric and neurological disorders. If lithium has been used in medical practice for several decades and has proven advantages for boosting mood and controlling aggressive and irritable tendencies, then why is its use still limited? Why has the science failed to catch up?

psychiatryredefined.org psychiatryredefined.org

The simple truth is this: because nutritional lithium is a low-cost, nutritional supplement, pharmaceutical companies reap little benefit from investing research funds to study its impact on mental health. However, more and more evidence points to lithium as a remedy for disruptive mood disorders and cognitive health, boosting happiness, increasing energy, preserving memory, and improving one’s attention.

5

Conclusion In my book, “Nutritional Lithium: a Cinderella Story: The Untold Tale of a Mineral That Transforms Lives and Heals the Brain,” the benefits of nutritional lithium are explored in much greater depth with hundreds of scientific references. Allen’s case offers one example of how nutritional lithium may dramatically improve a patient’s life without side effects. It is important to discuss cases like Allen’s to emphasize the limitation of the conventional psychiatric model for irritability and anger. Allen was on multiple ineffective medications for years, and struggled to maintain personal relationships and control his unpredictable outbursts and road rage.

psychiatryredefined.org

The story of lithium is a true Cinderella story. Lithium is an undervalued and underutilized solution to enhancing mood and controlling impulse behavior. We must do better for our patients. Lowdose lithium holds the power to transform our patients’ lives and provide relief without side effects for many suffering with from irritability and aggression.

6

REFERENCES 1. Pappadopulos E, Woolston S, Chait A, Perkins M, Connor DF, Jensen PS. Pharmacotherapy of aggression in children and adolescents: efficacy and effect size. J Can Acad Child Adolesc Psychiatry. 2006;15(1):27-39. 2. Greenblatt JM, Grossmann K. Nutritional Lithium: A Cinderella Story The Untold Tale of a Mineral That Transforms Lives and Heals the Brain. North Charleston, South Carolina: CreateSpace Independent Publishing Platform; 2016. 3. Leibenluft E, Cohen P, Gorrindo T, Brook JS, Pine DS. Chronic versus episodic irritability in youth: a communitybased, longitudinal study of clinical and diagnostic associations. J Child Adolesc Psychopharmacol. 2006;16(4):456-466. 4. Stringaris A, Cohen P, Pine DS, Leibenluft E. Adult outcomes of youth irritability: a 20-year prospective community-based study. Am J Psychiatry. 2009;166(9):1048-1054. 5. Dickstein DP. The Path to Somewhere: Moving Toward a Better Biological Understanding of Irritability. Am J Psychiatry. 2015;172(7):603-605.

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 his 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 at Walden Behavioral Care in Waltham, MA and serves as an Assistant Clinical Professor of Psychiatry at Tufts University School of Medicine and Dartmouth College Geisel School of Medicine. An acknowledged integrative medicine expert, educator, and author, Dr. Greenblatt has lectured internationally on the scientific evidence for nutritional interventions in psychiatry and mental illness. Through three decades of practice and research, Dr. Greenblatt is a leading contributor to helping physicians and patients understand the role of personalized medicine for mental illness. He is the author of seven books, including Finally Focused: The Breakthrough Natural Treatment Plan for ADHD; Nutritional Lithium: A Cinderella Story; Answers to Anorexia; Integrative Medicine for Alzheimer’s; Integrative Medicine for Binge Eating; and Integrative Medicine for Depression. Dr. Greenblatt is the founder of Psychiatry Redefined, an educational platform dedicated to the transformation of psychiatry. Psychiatry Redefined offers online CME-approved courses, webinars, and fellowships for professionals to learn about functional and integrative medicine for mental illness. To learn more, please visit www.JamesGreenblattMD.com.

psychiatryredefined.org

7