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Nervous - Successful treatment of Schizophrenia with phytotherapy

by Cabrera, Chanchal

Medical Herbalism 10-31-95 7(3): 1, 6, 8-15

February 1994

Ms. R. was thirty-four years old when she first consulted with me. She had been registered blind since birth although she does in fact retain some small degree of central vision. She attended this initial consultation accompanied by her friend, Lance, who was also blind, who seemed to know her very well and often helped her formulate her answers to my questions.

She was diagnosed with schizophrenia in 1989 and had been treated with Loxapine since then. Initially her doctor had prescribed high doses of the drug but over time she had been able to reduce the dose to a maintenance level of only 5 mg daily (therapeutic range 5 - 250 mg). An attempt in 1992 to reduce the dose further, using hypnotherapy as a supportive treatment, resulted in a repeat psychotic episode which caused her to be hospitalized and medicated on Chlorpromazine until she was stabilized again.

Ms. R. lived at home with her parents who were significantly unsupportive and who verbally and emotionally abused Ms. R. so that she felt isolated and victimized. This abusive parental behavior was verified by a friend so that I could be sure it was not a schizophrenic paranoia. She saw a psychiatrist monthly, although she did not feel that he offered her any emotional or practical support, and he did not do any counselling with her. The nature of her schizophrenia was that she felt an emotional disassociation and delayed emotional reactions. She also felt that she was often in a dreamy or twilight world, not really present in her life. She complained of significant memory loss such that was quite dysfunctional in society. She admitted to having great difficulty keeping a conversation going because she would forget what had been said within minutes. She did not have headaches and hallucinations were absent. She mentioned that her sleep was very disturbed and she might pass all the night in a `waking dream’ or sleep for ten or twelve hours. Her overall energy was quite good and she participated in various activities through the Canadian National Institute for the Blind.

Her general health was quite good with no respiratory, urinary, musculo-skeletal or cardiovascular symptoms at all. Her menstrual cycle was regular at twenty-eight days and there was no problem with the menses. There was some pre-menstrual symptoms for a couple of days each month, especially increased emotional lability and a tendency to be weepy. She used no birth control and her pap smears were always normal. The digestion was a little sluggish with a bowel movement only every other day.
 
 
 
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The diet was not very good, being pretty typical `meat and two vegetables’. She did have three regular meals a day but there was a notable lack of fruit, fresh vegetables or whole grains. She drank three or four glasses of water daily, as well as several cups of black tea and the occasional coke or other soft drink. She also took a daily multivitamin and mineral supplement and a garlic/parsley tablet.

Treatment plan

Ms. R’s. stated desire was to stop the Loxapine because she felt that it was largely responsible for the `brain fog’ she suffered from all the time. Because she had been on medications for a long time and had unsuccessfully attempted to come off them in the past, I felt that great caution was required in this case. I suggested that we spend about three months building and strengthening her system before attempting to reduce the drug. I made some dietary suggestions based on a need to increase the intake of fresh, living foods, and I gave her a printed sheet called ‘Basic Guide to Healthy Eating’. I specifically recommended that she eliminate refined sugar from her diet because of its known adverse effects on brain chemistry.

Herbal formula

Valerian (Valeriana off.)             (1:3) 10 ml

Chamomile (Chamomilla recutita)     (1:4) 20 ml

Hyssop (Hyssopus off.)             (1:3) 20 ml

Lemon Balm (Melissa off.)        (1:4 ) 20 ml

Lavender (Lavendula vera)         (1:4) 20 ml

Sweet Flag, Calamus (Acorus calamus)     (1:3) 10 ml

100 ml per week sig. 5 ml. tid. aq. cal. ac (Five mls three times a day in hot water before meals)

Valerian is a soothing, diffusive, relaxing and stimulating nervine, indicated for the relief of nervous irritation, and to support atonic and functional nervous disorders (Priest and Priest). I have found it to be particularly useful where both the relaxing and stimulating effects are required. It is also specifically indicated for sleep disturbance and to reduce the latency to fall asleep (British Herbal Compendium). Chamomile is another herb exhibiting both relaxing and stimulating properties. Its volatile oil content, rich in bisobolol and chamaezulene, is spasmolytic and relaxing to the smooth muscle and nervous tissue, while its bitter constituents provide a stimulating and tonifying effect upon the nervous system. It is especially indicated for nervous irritability and persistent low grade anxiety states (Priest and Priest). Hyssop is a stimulating and cleansing herb with an anti-spasmodic effect, acting on the central nervous system (Grieve, Zeylstra). It contains a volatile oil which has both a mild sedative and a nerve tonic action which results in a sense of relaxation, alertness and mental clarity (Tisserand). It has traditionally been used in treating epilepsy and other convulsive conditions and is considered to be regulating, balancing and normalizing to brain activity. Melissa or Lemon balm is considered to be one of the finest tonics and restoratives for nervous function (Zeylstra). It is traditionally used for depression and somnolence (lethargy and drowsiness) as well as for insomnia, agitation, anxiety states, nervous headaches, migraines and hysteria. Its sedative properties are particularly expressed through the volatile oil, inhalation of which has a marked and rapid effect. In the tincture form it has somewhat more of a stimulating and tonic effect due to the additional benefit of the bitters, resin and acids which are not significantly present in the pure volatile oil. Paracelsus called it ‘the elixir of life’ and Culpepper said that it “...causeth the mind and the heart to become merry...and driveth away all troublesome cares and thoughts out of the mind arising from melancholy and black choler.” Lavender is one of the most effective tonic nervines. Like the Melissa, Hyssop and Chamomile, it has both sedative volatile oils and stimulating bitters and thus serves to regulate and balance nervous function. Lavender volatile oil exhibits a balance of yin and yang energies and is thus especially effective in harmonizing extrovert and introvert tendencies in people (Tisserand). It shows especial benefit in psychological disorders such as depression, insomnia and hysteria. It is very effective in cases of mental exhaustion and where there are delusions or hallucinations (Grieve). The tincture of Lavender provides both a refreshing and a relaxing effect and it tends to regulate and steady the emotions. Sweet flag or Calamus demonstrates anti-spasmodic, relaxing and stimulating properties. The oleo-resin is rich in asarone, camphor, eugenol, pinenes and sesquiterpenes. It has traditionally been used in India for many generations as a powerful rejuvenative herb for the brain and nervous system, promoting cerebal circulation, increasing mental sensitivity, sharpening the memory and enhancing awareness (Frawley). In the treatment of schizophrenia specifically, Ayurvedic physicians use Sweet Flag to restore tranquillity to the mind (Bhagwan Dash).
 
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Ms. R was also prescribed a herbal tea consisting of equal parts of St. Johnswort and Skullcap. This was to be taken especially at night to aid sleep, and during the day if she felt herself becoming anxious or upset about something. St. Johnswort is especially indicated for depression and as a strong but gentle thymoleptic to raise the spirits and lift the mood (Weiss). Skullcap is calming and relaxing to the nervous system and is considered to be an excellent tonic nervine where there is a chronic anxiety state (Willard). It is especially useful in cases of nervous weakness, agitation, insomnia, nightmares and restless sleep conditions (Priest and Priest).

The overall intent of these herbs was to restore harmony and equilibrium to the thought process, and to nourish and strengthen the tissues and the psyche preparatory to reducing the allopathic medication. I particularly wanted to optimize her sleep pattern because it is during REM (rapid eye movement) sleep that most of our healing and regeneration occurs. If this is disrupted then deep healing on an organic, functional level is impaired. At this time I asked her to continue taking her prescription medication in the dose of 5 mg. daily.

April 1994

On her second visit to my office, Ms. R. was once again accompanied by her friend. She mentioned that she still felt nervous leaving the house alone and usually asked him to go places with her.

She reported a significant improvement in the quality and duration of her sleep. She now felt that she was going to sleep relatively easily and usually slept soundly right through the night, averaging seven hours sleep each night. Her memory and concentration were greatly improved and she had observed an increasing ease in maintaining conversations as her short term recall improved. She mentioned at this time the occurrence of occasional auditory hallucinations, especially sounds in the night, as she was going to sleep, that made her think there as someone in the room next door. They were not frightening her but she recognized them as hallucinations. I suggested that she increase the amount of herbal tea she took at night in an attempt to deepen the sleep a little further.
 
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She reported feeling more emotional stability and an overall improvement in her general sense of well being. She had made some minimal diet changes, being hampered in this by an unwillingness on the part of her family to make any adjustments in their eating habits. The main changes she had instigated were a piece of fruit daily, and a whole grain cooked cereal for breakfast each day. These minor changes had resulted in the bowel movements becoming daily.

She did mention on this visit some vulval discomfort, perhaps a mild yeast infection. I gave her a herbal/essential oil pessary to use nightly and an anti-fungal and anti-pruritic cream and suggested she use them for a week. If this did not effect a change she should consult with her doctor for further testing and treatment.

Herbal formula

Valerian (Valeriana off.)             (1:3) 10 ml

Hyssop (Hyssopus off)             (1:3) 15 ml

Sweet Flag, Calamus (Acorus calamus)     (1:3) 10 ml

Lemon Balm (Melissa off.)         (1:4) 20 ml

Lavender (Lavendula off.)         (1:4) 15 ml

Gotu Kola (Centella asiatica)         (1:3) 15 ml

Dandelion root (Taraxacum off.) radix     (1:3) 15 ml

100 ml per week sig 5 ml. tid. aq. ca. ac. [Five mls three times a day in hot water before meals]

Gotu kola (Centella asiatica) was included at this time to enhance oxygenation and the metabolic efficiency of the brain. In Ayurvedic medicine it is considered to be the most powerful rejuvenative nervine, increasing intelligence, longevity and memory, and decreasing senility and aging. It is also an effective blood purifier (alterative) and strengthens the adrenal glands (Frawley and Lad). Dandelion root was added to enhance the cleansing action of the formula. The intention was to aid in the elimination of toxins that may be adversely affecting the mental health, and to promote the possible hepatic elimination of the Loxapine. The bitter properties of dandelion make it the pre-eminent tissue and blood cleansing herb, while its considerable nutrient profile make it valuable wherever debility and lassitude are a problem.
 
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    Medical Herbalism: Clinical Articles and Case Studies

I also prescribed a compound Bach Flower remedy consisting of the following remedies: Gentian for despondency, melancholia, depression and discouragement; Centaury for timidity and being easily influenced by others; Scleranthus for indecision, uncertainty, emotional lability and difficulty standing up for oneself; Cerato for doubt of your own abilities, judgements or beliefs and difficulty in making decisions; Clematis for being dreamy, inattentive, with-drawn, introverted, drowsy, listless and absent-minded, and Gorse for hopelessness and despair. These were dispensed at a strength of 4 drops each of the mother tincture in 25 mls. spring water, to be taken in a dose of 4 drops 4 times daily.

At this time I contacted the psychiatrist that Ms. R. was seeing and obtained his permission to have her reduce the dose of Loxapine to 3.75 mg. daily (a subclinical dose). The doctor was agreeable to trying this because he had seen such an improvement in Ms. R.’s mental state since she had begun to take the herbs, although he expressed his belief that she would almost certainly have a relapse on this low dose of medication.

June 1994

On her third visit Ms. R. reported progress on all fronts. Her memory, clarity of thought, concentration and self-confidence continued to improve and she felt more emotional stability than she had known for many years. She had not reduced her dose of Loxapine but said that she now felt ready to try. Her bowel movements continued to occur daily. She reported increased energy and enthusiasm. She had started swimming lessons and was riding a tandem bicycle several times a week with a sighted friend.

Herbal formula

The herbal formula, tea and Bach Flower remedy were repeated unchanged.

July 1994

On her fourth visit Ms. R reported further positive changes. She had reduced the Loxapine to 3.75 mg daily and had become aware of a slight increase in the auditory hallucinations and a slight decrease in the quality of sleep, but an overall improvement in energy and general well-being. Her memory continued to improve and she felt that her social interactions were becoming progressively easier as she “came out of her shell.”

Herbal formula

Valerian (Valeriana off)                 (1:3) 15 ml

Hyssop (Hyssopus off.)                 (1:3) 20 ml

Sweet Flag, Calamus (Acorus calamus)         (1:3) 10 ml

Lemon Balm (Melissa off.)             (1:4) 15 ml
 
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Lavender (Lavandula vera)             (1:4) 15 ml

Dandelion root (Taraxacum off.) radix         (1:3) 10 ml

Gotu Kola (Centella asiatica)             (1:3) 10 ml

European Mistletoe (Viscum album)         (1:10) 5 ml

100 ml per week sig. 5 ml. bid. aq. cal. ac. [5 mls twice a day in hot water before meals]

European mistletoe (Viscum album) was added to the formula as a powerful central nervous system relaxant especially effective in loss of memory, irritability and chronic anxiety (Weiss). The plant also contains sympathomimetic amines which raise the sympathetic tone in the body and assist in energy balancing.

The dose was dropped at this time to twice daily in an attempt to reduce her costs and to test out the reliance of her body on the herbs.

The Bach Flower remedy and the herbal tea were repeated.

September 1994

At this fifth visit Ms. R. reported a continued improvement in her situation. She had been away to cousins in the country for a holiday and felt much better to be away from her emotionally abusive family. She had resolved that once her mental health was fully stabilized she would seek sheltered housing for herself. She felt that this was a very significant decision — to leave home and live alone — and she believed that she had been aided in reaching this courageous decision by the Bach Flower remedy. She described a great reduction in the auditory hallucinations and a continued improvement in her memory and concentration. She had maintained her dose of Loxapine at 3.75 mg. daily.

This was the first visit that she made to my office without her friend, and she reported an increasing self confidence and ability to initiate activities in her life. She described, however, a lack of fun and laughter in her life and told me how serious she was most of the time. I suggested that she set herself a challenge to do one fun thing each week.

Herbal formula

Her previous formula, Bach Flower remedy and herbal tea were repeated but the dose on the herbal formula was reduced to 5 ml once a day.

October 1994

On her sixth visit Ms.R reported continued improvement in her schizophrenic symptoms. She was still taking 3.75 mg. Loxapine daily and I suggested that she go ahead and drop the dose to 2.5 mg.
 
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She had recently had a gall bladder attack and an ultrasound had determined the presence of several small gall stones. She had decided to go ahead and have laser surgery to remove the stones. I mentioned various herbal and dietary approaches but she felt that they would be too difficult for her to carry out and she preferred to take the easier option. I concurred with her decision because I did not want to do anything which could have disrupted her mental state or precipitate a decline in the positive changes we had so far effected.

Herbal formula

The herbal formula, Bach Flower remedy, and herbal tea were repeated. She was instructed to increase the dose of her herbal formula back up to two or three times daily if she noticed any deterioration of her mental condition as the Loxapine was reduced.

December 1994

On this visit Ms. R. reported that she was scheduled for the gall bladder surgery just after Christmas. She had reduced the Loxapine to 2.5 mg daily and was feeling progressively more clear headed and emotionally stable. She had been away to visit her cousins again and was now quite distressed at having to live at home with her parents. Her father in particular had been quite abusive and she was actively making necessary plans to move out on her own.

Herbal formula

Her herbal formula, Bach Flower remedy and herbal tea was repeated.

January 1995

Ms. R. reported that when she went for the laser surgery on the gall stones, they were found to be inoperable so her gall bladder was removed. She had healed up very well and appeared to be suffering no repercussions. She had succeeded in dropping her dose of Loxapine down to only 1.25 mg daily and was feeling very pleased about this. She said that she was not having any auditory hallucinations or delusional thoughts and felt very happy and stable. She described how prayer and positive affirmations helped her to cope with the difficult