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Other names: Abilify
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EVENING PRIMROSE OIL IN THE TREATMENT OF SCHIZOPHRENIA
There was recently a double-blind trial on Efamol on abnormal movements, psychiatric status and memory on patients with tardive dyskinesia, which showed that evening primrose oil produced significant results in certain aspects of schizophrenia. Memory, and total psychopathology scores improved significantly, and there was a marginal improvement on involuntary abnormal movements.
Tardive dyskinesia (involuntary abnormal movements). Up to 60% of patients on neuroleptic drugs suffer from motor disorders such as tardive dyskinesia as a side-effect. These involuntary abnormal movements are severely disabling and intractable.
In a preliminary study by Dr Vaddadi, it was noticed that there was a sudden reduction in these involuntary movements in some of his schizophrenic patients while they were being treated with evening primrose oil and penicillin. These early findings have been backed up by further studies.
The success of Dr Vaddadi’s work led to a full-scale double-blind trial involving several centres1: the Department of Psychiatry at Crawley Hospital, West Sussex, St George’s Hospital Medical School, London, the Department of Psychology, Middle East Technical University, Ankara, Turkey, and the Efamol Research Institute in Kentville, Nova Scotia, Canada. As well as researching the effects of evening primrose oil on tardive dyskinesia, they also looked at the oil’s effects on psychiatric status, and on memory.
The trial involved 48 psychiatric patients with established movement disorders who had been on neuroleptic drugs over a long period of time. Thirty-nine of these patients were schizophrenic, four manic-depressive, and three had personality disorders. All of them had involuntary abnormal movements of at least mild severity. Patients were kept on their existing medication, and were matched against controls.
The patients were given either Efamol, or a placebo, for 16 weeks. The dose was 12 capsules of Efamol (or a placebo) divided up over the day. At the end of the 16 week period, there was a cross-over, so that the patients who had been on the Efamol received the placebo instead, and vice versa.
Assessments were made at the beginning of the trial and then at two-weekly intervals throughout the trial. Blood samples were also collected and analyzed.
The results of these blood tests showed that all psychiatric patients had below-normal levels of essential fatty acids. Patients with severe tardive dyskinesia had the lowest levels – significantly lower than both the patients without any movement disorder, and also those with only mild movement disorder.
This shows that there is an association between low levels of essential fatty acids, and the presence and severity of tardive dyskinesia. There is also a close association between low levels of essential fatty acids and psychosis. Giving supplements of essential fatty acids to these patients produced a move towards normal in their red cell membranes, but they did not reach normal levels.
The overall results of this trial on tardive dyskinesia showed a small but significant improvement with Efamol. However, this study on human psychiatric patients was not as convincing as previous animal experiments which had shown that essential fatty acids do have a noticeable effect on abnormal movements.
Perhaps the reason why this trial had slightly disappointing results was because there are irreversible structural changes to the brain in patients with severe and prolonged movement disorders; perhaps the dose was too low and the treatment period too short. There may also be a problem with absorbing essential fatty acids; it probably takes much longer to correct abnormal levels of essential fatty acids in the brain, than in red blood cells. Further research is planned to see whether the results could be more positive with a higher dose over a longer treatment period.
Even though the results of this trial were only marginally significant for the role of evening primrose oil in tardive dyskinesia, it is still worthwhile giving supplements of evening primrose oil, together with neuroleptic drugs, in the prevention and management of this disease.
Memory and psychiatric status. The effect of Efamol as an antipsychotic and as an improver of memory in tests was much more pronounced than its effects on tardive dyskinesia.
There was a mean improvement of 20% to 30% in the psychopathology scores at the end of the treatment with evening primrose oil. This improvement occurred in chronic patients with schizophrenia for whom orthodox neuroleptic therapy had little to offer. This related especially to the ‘negative’ symptoms of schizophrenia, such as ‘flat’ emotions and social withdrawal.
With memory, there was a clear deterioration when patients switched from active treatment to placebo. Other studies have shown that Efamol improves cerebral function to a significantly greater degree than a placebo.
*39/60/5*
