Bipolar depression eased by pig feed. A nutritional supplement developed when a livestock products salesman noticed similarities between the behavior of a distraught neighbor’s bipolar children and aggressive pigs’ ear-and-tail-biting syndrome has proven successful in reducing medication needs in a large study of bipolar depressed patients.

For close to a century, agricultural scientists have done research on the impact of nutrients on animal behaviour. Aggressive behaviour is routinely treated with food supplements. Oddly, this body of knowledge has not made its way into human medicine. Without a blueprint to guide them, Mr. Hardy and Mr. Stephan concocted a mixture of vitamins and minerals.

This Globe and Mail article is being heavily blinked to. Here are some of my thoughts (in the direction of measured optimism but not over-the-top enthusiasm):

• The psychiatric treatments the patients in the vignettes described had had before trying the nutritional supplement sound like caricatures of bad treatment. Prescribing nine medications together, exploding at patient and family when one’s expertise is questioned, etc. A subset of people will improve when just removed from such adverse treatment conditions. The nutritional supplement might be a red herring in these cases.
  

• The study was not double blinded and not placebo controlled. Time and again, apparent treatment success in preliminary studies is not replicated with rigorous study designs that remove hidden experimenter and subject biases.
• The idea that a simple nutritional supplement could replace medication — and its corollary, that a devastating disease can be reduced to an overlooked dietary factor or factors — often represents a sort of magical thinking — yearning for a ‘quick fix’ — on the part of sufferers and families faced with a difficulty accepting a disease recovery from (or stabilization with)which requires instead a long patient and courageous commitment on their part. You know the old saying — if a breakthrough sounds too good to be true, it probably is. The degree of skepticism required in reacting to a claim is in direct proportion to its momentousness…
  

• Remaining with the too-good-to-be-true theme, you’ll see a series of case reports on the website of the company set up to distribute the supplements claiming efficacy in almost the entire spectrum of psychiatric ailments (anxiety disorders, bipolar disorder, fibromyalgia/chronic fatigue, Tourette’s Syndrome, ADHD, depression and schizophrenia).
  

• One of the longest-running subthreads in psychiatric treatment controversy is that of nutritional treatments. I’ll mention just two prominent ones, mega-vitamin therapy for schizophrenia (a la Linus Pauling et al) and the Feingold Diet for children with attention deficit disorder. They never pan out. And there’s an entire subgenre of alternative medicine called clinical ecology which focuses on allergies, environmental and dietary influences on emotional and physical health, which I’ve looked into at depth and find remarkable for its conceptual confusion and pseudoscience.
  

• I’m not, however, saying that there are no dietary influences on mood. If you’re serious about this area, you have to be familiar with the groundbreaking lifelong commitment of Dr Judith Wurtman at MIT to reputable research in this area. And well-designed clinical trials have shown beneficial effects of a nutritional supplement, omega three fatty acids, in treatment-resistant bipolar disorder. While the components of the Hardy-Stephan supplements are a proprietary secret, it contains “only non-prescription nutrients”. It seems likely that only one or two components of this “shotgun approach” supplementation are the crucial factors. It would be nice to get the cost down below the certainly excessive $250 a month desperate families are paying. I was reassured to hear that the company distributing the product is non-profit, at least.
  

• Improvement in “bipolar depression” over a six-month followup period might be expected just from the natural history of the disorder, which tends to be cyclical and sometimes seasonal, relapsing and remitting. And dietary effects might be nonspecific, i.e. enhancing overall wellbeing rather than exerting a specific stabilizing effect on a clinical disorder.