Whole Psychiatry and OCD

Before we begin the detailed discussion of OCD, it is very important to note that in the 1990’s Dr. Sweedo discovered that a sub-group of children who had Strep throat went on to develop what she called PANDAS (Pediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcus). This syndrome included OCD. She found that if she filtered the children’s blood, removing the immune complexes (antibodies made by the body to attack the Strep bacteria, but at the same time attacking a part of the brain), the OCD cleared immediately. This demonstrates that the immune system plays a role in brain disorders, and there is now lots of evidence for this in mood disorders as well as with OCD.

Demonstrating this, I saw a young woman two years ago who was a student at Yale. In her first year, she was riddled with OCD. She came to me because she did not want to take medication. After a thorough work up we found three infections (in her gut) and multiple food allergies, multiple nutritional deficiencies, and one hormonal problem.

By treating the infections and eliminating the food allergies, while repairing the gut, we reduced the inflammation in the brain. Combining much needed nutrients, one supplement for OCD (Inositol), and one hormone with a behavioral therapy (exposure and response prevention), this young woman has been “95%” well for nearly three years without any medication.

This is the Whole Psychiatry approach to OCD, and it works quite well. It is significant because the standard approach to OCD (medication and exposure and response prevention therapy) leaves many individuals only partially treated and with short and long term side effects, and metabolic consequences that affect long term health (diabetes, osteoporosis, metabolic syndrome).

The links between the immune system and OCD are many. One important link, which goes beyond the very specific PANDAS syndrome, is the fact that infection or inflammation anywhere in the body causes changes in the brain’s ability to make serotonin. In this scenario, cytokines (hormones of the immune system) activate an enzyme (IDO) in the brain, which takes tryptophan, and instead of making serotonin from it, makes something called kyneurenin and quinolinic acid. These cause increases in dopamine (as serotonin goes down, dopamine goes up, which increases tics and stereotypical behaviors) and activation of excitatory pathways (NMDA/glutamate) leading to anxiety. Thus the immune inflammatory pathways are critical pathways in the genesis of the OCD. Medications are only partially effective, as they do not address this aspect of the disorder.

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