- Email: [email protected]
In response to re: Less is more
Schizophrenia Research 161 (2015) 520
Contents lists available at ScienceDirect
Schizophrenia Research journal homepage: www.elsevier.com/locate/schres
Letter to the Editor In response to re: Less is more
Contribution I declare that I am the sole contributor to this manuscript. Acknowledgment I would like to thank Dr. Peter J. Weiden for being the first to recognize the need for a pilot safety trial of alpha lipoic acid as adjunctive therapy in the treatment of schizophrenia and for his support in working toward that goal.
In re: Less is more (Emsley et al., 2014a, 2014b). Dr. Emsley claims “It could be equally argued that the dose we selected was too low. Two more recent studies investigating the effects of ALA on weight and metabolic profile in patients with schizophrenia used doses of 1200 mg/d. In these studies the ALA was well tolerated and there was no change in clinical status (Kim et al., 2008; Ratliff et al., 2013).” Unlike the Emsley trial (Emsley et al., 2014a, 2014b) in which omega-3 and ALA were given after antipsychotics had been discontinued, in the studies by Kim and Ratcliff ALA was given in addition to antipsychotics. This is an important distinction. The three recent studies where schizophrenia patients on antipsychotics were given ALA dosages higher than the amount that gave Altschule problems (Altschule et al., 1959; Kim et al., 2008; Ratliff et al., 2013), 1200 mg/d, (Vidović et al., 2014), 500 mg/d, suggest that the combination is protective. None reported symptom relapse but there was no improvement in mental status either. Interestingly, Vidovic concluded: “LA supplementation decreased lipid peroxidation and oxidative damage of proteins and improved non-enzymatic antioxidant capacity in healthy controls. No significant changes were observed on oxidative damage in patients with schizophrenia.” Whether low dose adjunctive ALA in the 50 to 100 mg/d range can improve clinical response in an equal or greater percentage of patients than was shown by Giamattei (Giamattei, 1957) and Altschule still remains to be discovered. Conflict of interest I declare that there are no conflicts of interest.
http://dx.doi.org/10.1016/j.schres.2014.11.004 0920-9964/© 2014 Elsevier B.V. All rights reserved.
References Altschule, M.D., Goncz, R.M., Holliday, P.D., 1959. Carbohydrate metabolism in brain disease. XI. Effects of thioctic (alpha-lipoic) acid in chronic schizophrenia. AMA Arch. Intern. Med. 103, 726–729. Emsley, R., Chiliza, B., Asmal, L., du Plessis, S., Phahladira, L., van Niekerk, E., van Rensburg, S.J., Harvey, B.H., 2014a. A randomized, controlled trial of omega-3 fatty acids plus an antioxidant for relapse prevention after antipsychotic discontinuation in first-episode schizophrenia. Schizophr. Res. http://dx.doi.org/10.1016/j.schres.2014.06.004. Emsley, R., et al., 2014b. Re: less is more. Schizophr. Res. http://dx.doi.org/10.1016/j. schres.2014.10.014. Giamattei, L., 1957. Thioctic acid in therapy of schizophrenia. Osp. Psichiatr. 25, 221–228. Kim, E., Park, D.W., Choi, S.H., Kim, J.J., Cho, H.S., 2008. A preliminary investigation of alpha-lipoic acid treatment of antipsychotic drug-induced weight gain in patients with schizophrenia. J. Clin. Psychopharmacol. 28 (2), 138–146. Ratliff, J.C., Palmese, L.B., Reutenauer, E.L., Tek, C., 2013. An open-label pilot trial of alpha lipoic acid for weight loss in patients with schizophrenia without diabetes. Clin. Schizophr. Relat. Psychoses. 7, 1–13. Vidović, B., Milovanović, S., Dorđević, B., Kotur-Stevuljević, J., Stefanović, A., Ivanišević, J., Miljković, M., Spasić, S., Stojanović, D., Pantović, M., 2014. Effect of alpha-lipoic acid supplementation on oxidative stress markers and antioxidative defense in patients with schizophrenia. Psychiatr. Danub. 26 (3), 205–213 (Sep).
Sheila E.J. Seybolt 7635 Jackson Blvd, Forest Park, IL 60130, USA Tel.: +1 708 366 0049, +1 708 985 5326. E-mail address: [email protected]. 3 November 2014
Contents lists available at ScienceDirect
Schizophrenia Research journal homepage: www.elsevier.com/locate/schres
Letter to the Editor In response to re: Less is more
Contribution I declare that I am the sole contributor to this manuscript. Acknowledgment I would like to thank Dr. Peter J. Weiden for being the first to recognize the need for a pilot safety trial of alpha lipoic acid as adjunctive therapy in the treatment of schizophrenia and for his support in working toward that goal.
In re: Less is more (Emsley et al., 2014a, 2014b). Dr. Emsley claims “It could be equally argued that the dose we selected was too low. Two more recent studies investigating the effects of ALA on weight and metabolic profile in patients with schizophrenia used doses of 1200 mg/d. In these studies the ALA was well tolerated and there was no change in clinical status (Kim et al., 2008; Ratliff et al., 2013).” Unlike the Emsley trial (Emsley et al., 2014a, 2014b) in which omega-3 and ALA were given after antipsychotics had been discontinued, in the studies by Kim and Ratcliff ALA was given in addition to antipsychotics. This is an important distinction. The three recent studies where schizophrenia patients on antipsychotics were given ALA dosages higher than the amount that gave Altschule problems (Altschule et al., 1959; Kim et al., 2008; Ratliff et al., 2013), 1200 mg/d, (Vidović et al., 2014), 500 mg/d, suggest that the combination is protective. None reported symptom relapse but there was no improvement in mental status either. Interestingly, Vidovic concluded: “LA supplementation decreased lipid peroxidation and oxidative damage of proteins and improved non-enzymatic antioxidant capacity in healthy controls. No significant changes were observed on oxidative damage in patients with schizophrenia.” Whether low dose adjunctive ALA in the 50 to 100 mg/d range can improve clinical response in an equal or greater percentage of patients than was shown by Giamattei (Giamattei, 1957) and Altschule still remains to be discovered. Conflict of interest I declare that there are no conflicts of interest.
http://dx.doi.org/10.1016/j.schres.2014.11.004 0920-9964/© 2014 Elsevier B.V. All rights reserved.
References Altschule, M.D., Goncz, R.M., Holliday, P.D., 1959. Carbohydrate metabolism in brain disease. XI. Effects of thioctic (alpha-lipoic) acid in chronic schizophrenia. AMA Arch. Intern. Med. 103, 726–729. Emsley, R., Chiliza, B., Asmal, L., du Plessis, S., Phahladira, L., van Niekerk, E., van Rensburg, S.J., Harvey, B.H., 2014a. A randomized, controlled trial of omega-3 fatty acids plus an antioxidant for relapse prevention after antipsychotic discontinuation in first-episode schizophrenia. Schizophr. Res. http://dx.doi.org/10.1016/j.schres.2014.06.004. Emsley, R., et al., 2014b. Re: less is more. Schizophr. Res. http://dx.doi.org/10.1016/j. schres.2014.10.014. Giamattei, L., 1957. Thioctic acid in therapy of schizophrenia. Osp. Psichiatr. 25, 221–228. Kim, E., Park, D.W., Choi, S.H., Kim, J.J., Cho, H.S., 2008. A preliminary investigation of alpha-lipoic acid treatment of antipsychotic drug-induced weight gain in patients with schizophrenia. J. Clin. Psychopharmacol. 28 (2), 138–146. Ratliff, J.C., Palmese, L.B., Reutenauer, E.L., Tek, C., 2013. An open-label pilot trial of alpha lipoic acid for weight loss in patients with schizophrenia without diabetes. Clin. Schizophr. Relat. Psychoses. 7, 1–13. Vidović, B., Milovanović, S., Dorđević, B., Kotur-Stevuljević, J., Stefanović, A., Ivanišević, J., Miljković, M., Spasić, S., Stojanović, D., Pantović, M., 2014. Effect of alpha-lipoic acid supplementation on oxidative stress markers and antioxidative defense in patients with schizophrenia. Psychiatr. Danub. 26 (3), 205–213 (Sep).
Sheila E.J. Seybolt 7635 Jackson Blvd, Forest Park, IL 60130, USA Tel.: +1 708 366 0049, +1 708 985 5326. E-mail address: [email protected]. 3 November 2014