Nicotinic Acid in the Treatment of Schizophrenias

Abstract

After reviewing the literature on nicotinic acid in the treatment of schizophrenia, the authors present the results of the Canadian collaborative study. The data indicate that nicotinic acid has no therapeutic effect of schizophrenia.

A Review of Nicotinic Acid, N-Methylated Indoleamines and Schizophrenia

“…In variance with the notion that increased transmethylation is responsible for schizophrenic symptoms are the findings that methyl acceptors such as nicotinic acid at doses up to 3,000 mg daily (Ban and Lehmann, 1975), or butylgallate in doses of 5,000 mg daily {Baldessarini, 1975) do not improve schizophrenia.…”

Nicotinic Acid in the Treatment of Schizophrenias: Canadian Mental Health Association Collaborative Study Progress Report II

“…In five of these studies the hypothesis was tested that nicotinic acid has a beneficial action over and above the effects achievable by standard treatments; in three studies the therapeutic efficacy of nicotinic acid is presumably facilitated by the administration of ascorbic acid, pyridoxine and d'penicillamine; in three studies, the presence of the 'mauve factor', 'pink spot', or a 'bufotenin-like substance' in the urine as indicators of a favourable therapeutic outcome with nicotinic acid is to be tested; and in one study, that exacerbation of schizophrenic psychopathology, induced by the associated administration of a methyl-donor and a monoamine oxidase inhibitor, can be prevented or counteracted by nicotinic acid administration. The First Progress Report on the CMHA Collaborative Study was presented at the Annual Meeting of the Canadian Psychiatric Association in June 1970 and published by the Canadian Mental Health Association later that year (6). In view of the controversial clinical findings in the first two completed clinical trials (1,24), and in the absence of verified indicators of therapeutic responsiveness, Progress Report I concluded that the practical decision as to whether nicotinic acid should be prescribed must be influenced by consideration of its known adverse effects.…”

“…In this context it was pointed out that dermatological (flushing, skin rash and dermatitis), gastrointestinal (sialorrhea, heartburn, nausea, vomiting and diarrhea), hepatic (liver function abnormality) and cardiovascular (hypotension, tachycardia and syncope) symptoms were rather commonly associated with high doses of nicotinic acid administration during the first three-and-a-half years of the CMHA Collaborative Study. Progress Report I was followed within eight months by Complementary Report A, which was presented at the Annual Meeting of the Research Directors of the CMHA in 1971, and was published by the Canadian Mental Health Association later that year (5). Based on the negative findings in three out of the first four completed clinical trials, Complementary Report A concluded that nicotinic acid therapy is not the optimal treatment for the average schizophrenic patient.…”

“…More detailed discussions of the theoretical rationales for the nicotinic acid treatment of schizophrenia can be found in Progress Report I (6) and Complementary Report A of the CMHA (5).…”

Negative Findings with Nicotinic Acid in the Treatment of Schizophrenias

“…In view of the controversy regarding the effectiveness of nicotinic acid treatment the Board of Directors of the Canadian Mental Health Association (CMHA), approximately 6 years ago, set up a series of systematic studies to obtain relevant information on nicotinic acid treatment {Ban, 1971a, b , Ban and Lehmann, 1970).…”