From the Editor

Are you neuroprotecting your patients? 10 Adjunctive therapies to consider

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Cox-2 inhibitors. This is a well-known class of anti-inflammatory drugs, which are FDA-approved for pain and inflammation. Studies of adjunctive use of cox-2 inhibitors in acute psychosis show that these drugs accentuate the efficacy of antipsychotic medications.11 The reason is that acute psychosis is associated with neuro-inflammation, which leads to neurotoxicity.

Lithium. Dosages to treat mania are usually 900 to 1500 mg/d. However, in minute (homeopathic) dosages as low as 1 mg/d, lithium has been shown to prevent progression of amnestic mild cognitive impairment to full dementia.12 This interesting observation suggests that lithium not only induces neurogenesis and increases gray matter volume,13 but may be neuroprotective against amyloid neurotoxicity. The effects of very low doses of lithium in depression and schizophrenia have not been studied yet.

Caffeine. Yes, the good old brew people seek all day is neuroprotective and prevents mood and memory dysfunction caused by stress.14 Caffeine should be avoided in patients with anxiety disorders, but it may be helpful for the brains of patients with mood or psychotic disorders. Caffeine reverses synaptic dysfunction in the circuits of the hippocampus caused by chronic unpredictable stress (quite common among our psychiatric patients).

The above interventions may be helpful for some patients but not others. Practitioners should consider using 1 or more of those adjunctive neuroprotective agents in patients who are at risk for neurodegenerative changes secondary to recurrences of acute and severe psychosis or mood episodes. Although clinicians cannot monitor brain structural integrity, they can assess the rate of symptomatic improvement and degree of functional restoration in their patients. Until a cure is found, these little steps—taken cautiously and judiciously—could help alleviate our patients’ suffering and the risk of neurotoxicity associated with their serious psychiatric disorder.

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