Thinking a little prophylactically here…
First off, a disclaimer: I am just thinking out loud with what little knowledge I have about psychosis. But what I do know is that anything that I say in this article wouldn’t make a mental health situation worse.
Today I have finished an essay for my MSc homework where I had to critically analyse the role of dopamine in the development of psychosis. Part of the observable development of psychosis involves the ‘prodrome’ phase where there are subtle changes in a person before they start experiencing delusional beliefs or hearing voices.
There is ongoing research to find a treatment pathway that could intervene at this critical stage before full-blown psychosis develops, especially in young people. This stage can be a change in mood where an individual ‘often has the sense that something odd but important or threatening is going on around them that they cannot quite explain’. It seems like they experience a mental and emotional overload which they cannot cope with, and it seems as if they have a ‘growing sense that things and events around them have a hidden important meaning, although at this stage they are unsure what this is and often describe a sense that the world has changed in some way they cannot pin down.’ 1
Obviously, if this is the beginning of a lifelong struggle with mental health issues that could involve various antipsychotic medications that may or may not work, but which can more reliably bring unwanted side-effects – then wouldn’t it be fantastic if this could be headed off at the get-go? There has been quite a bit of interest in this as schizophrenia is a difficult condition to successfully medicate. As long ago as 2016 there were pilots of suitable ‘interventions’ to prevent of delay the transition into psychosis for those at risk that could be identified as experiencing the prodromal symptoms. 2
One could ask, what is actually going on in the brain? If that is unknown, then the treatment would develop as a scattergun approach – hoping to hit something useful.
It seems that there is a culmination of factors [genetic predisposition/childhood trauma/ environmental factors etc] that hypersensitise the response of certain neurotransmitters over time which results in something called ‘aberrant salience’, when neutral stimuli feel intensely meaningful, driving delusional beliefs. This transition from prodrome to psychosis develops as dopamine dysregulation intensifies gradually. Initially, individuals notice subtle changes in their perception of everyday experiences. This progresses to an increasing preoccupation with finding meaning in coincidental events, finally culminating in fully formed delusional beliefs as the brain processes false signals.
Of course, it is not just dopamine – the body is more complex than that.
There are several neurotransmitter systems, all doing slightly different things: Glutamate dysfunction, particularly NMDA receptor hypofunction, can lead to excessive glutamate release that disrupts neural circuits and contributes to cognitive symptoms. GABA deficits reduce inhibitory control, potentially allowing excessive dopamine release and contributing to neural noise that can manifest as disorganized thinking. Serotonergic system disturbances, especially at 5HT2A receptors, can alter sensory processing and contribute to perceptual disturbances. All these neurotransmitter systems form a complicated network where dysfunction in one area can cascade through the others, and one ends up with psychotic symptoms.
I know, I know – this is an oversimplification of the whole thing, but I did say I was just thinking out loud…
What if it were possible to find medicinal herbs that could damp down this hypersensitive reaction? In this hypothetical world, what could we do, if anything?
It isn’t as straightforward as saying let’s use sedatives/herbs that inhibit glutamate/anti-inflammatories/adaptogens. We don’t aim to replace drugs with herbs because we have to understand the process, and we would hit the same problem as the psychiatrists – to whit; would we propose the hoist medicinal herbs onto every single person experiencing what we could identify as a ‘prodrome’?
No, idea – but I am still thinking about what I would do. Two things I do know; firstly, not everybody who experiences such a prodrome and is classed as ‘at risk’ goes on to develop psychosis, and secondly, nutritive herbs wouldn’t make the situation worse.
So for now, I will just go on thinking…
If you would like to join my monthly membership for £9.99 a month we have a monthly Q&A, and I regularly put up videos about medicinal herbs and the herbal life.
1 Winton-Brown, T.T., Fusar-Poli, P., Ungless, M.A. and Howes, O.D. (2014) ‘Dopaminergic basis of salience dysregulation in psychosis’, Trends in Neurosciences, 37(2), pp. 85-94.
2 Woodberry, K.A., Shapiro, D.I., Bryant, C. and Seidman, L.J. (2016) ‘Progress and future directions in research on the psychosis prodrome: a review for clinicians’
